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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on August 6, 2009, at 15:03:07
In reply to Re: Popular Antidepressants: How They Stack Up » bulldog2, posted by tensor on August 6, 2009, at 14:48:18
> >The more I talk to doctors the more I realize how poorly they are educated in the area of psychotropic meds.
>
> Sad but true.My doctor recently took a CME course in psychopharmacology. To his surprise, there was quite a bit of attention paid to MAOIs.
- Scott
Posted by linkadge on August 6, 2009, at 17:23:56
In reply to Re: Popular Antidepressants: How They Stack Up, posted by SLS on August 6, 2009, at 15:03:07
I agree that there is no way that mirtazapine is #1 in efficacy. I have spoken to dozens of psychiatrists both online and in person. None would suggest that mirtazapine has been seriously effective in clinical practice.
I've seen so few trials comparing it long term to other agents. I think there is research to suggest it may work faster than SSRI's, but I don't think there is head to head reasearch to suggest it works better long term.
I've certainly seen nobody here who has done well on mirtazapine monotherapy.
Linkadge
Posted by SLS on August 6, 2009, at 17:47:10
In reply to Re: Popular Antidepressants: How They Stack Up, posted by linkadge on August 6, 2009, at 17:23:56
> I've certainly seen nobody here who has done well on mirtazapine monotherapy.
I certainly didn't.
Regardless of where the rate of treatment success of Remeron lies compared to other antidepressants, it should nonetheless be used optimally when it is chosen. That would include using dosages of 45-90mg.
- Scott
Posted by Alexanderfromdenmark on August 6, 2009, at 18:38:47
In reply to Re: Popular Antidepressants: How They Stack Up, posted by linkadge on August 6, 2009, at 17:23:56
> I agree that there is no way that mirtazapine is #1 in efficacy. I have spoken to dozens of psychiatrists both online and in person. None would suggest that mirtazapine has been seriously effective in clinical practice.
>
> I've seen so few trials comparing it long term to other agents. I think there is research to suggest it may work faster than SSRI's, but I don't think there is head to head reasearch to suggest it works better long term.
>
> I've certainly seen nobody here who has done well on mirtazapine monotherapy.
>
> Linkadge
Actually Remeron is the only drug that has given me somewhat remession of symptoms in terms of increased energy and motivation, improved mood. But efficacy was somewhat unstable and I was also got very agitated. I wish I had toughed it out and given it 6 weeks. It's very had to adjust to because it makes you SLEEP and sleepy, groggy and tired.
Posted by tensor on August 7, 2009, at 4:53:25
In reply to Re: Popular Antidepressants: How They Stack Up, posted by linkadge on August 6, 2009, at 17:23:56
> I agree that there is no way that mirtazapine is #1 in efficacy. I have spoken to dozens of psychiatrists both online and in person. None would suggest that mirtazapine has been seriously effective in clinical practice.
>
> I've seen so few trials comparing it long term to other agents. I think there is research to suggest it may work faster than SSRI's, but I don't think there is head to head reasearch to suggest it works better long term.
>
> I've certainly seen nobody here who has done well on mirtazapine monotherapy.
>
> LinkadgeI, on the other hand, know plenty of people who have done great on Remeron only. I'm one example, Remeron worked great for many years until I started using benzos. Remeron was the third AD I tried after earlier treatments with Prozac and Effexor have failed.
Posted by SLS on August 7, 2009, at 6:56:16
In reply to Re: Popular Antidepressants: How They Stack Up » linkadge, posted by tensor on August 7, 2009, at 4:53:25
> I, on the other hand, know plenty of people who have done great on Remeron only. I'm one example, Remeron worked great for many years until I started using benzos. Remeron was the third AD I tried after earlier treatments with Prozac and Effexor have failed.
What dosages of Remeron have you used, and what were the results?
Thanks.
- Scott
Posted by tensor on August 7, 2009, at 8:51:04
In reply to Re: Popular Antidepressants: How They Stack Up » tensor, posted by SLS on August 7, 2009, at 6:56:16
> What dosages of Remeron have you used, and what were the results?
>
> Thanks.
>
>
> - ScottFirst time it helped me I took 30mg, the response was massive, the remission was 100%. After a year I went down to maintenance dose of 15mg. I have been up to 60mg but without any further benefits. I'm now on 45mg and I'm starting to get some energy back finally, although it's the first day on 45mg, I stepped up yesterday from 30mg. It may be that 30mg is enough but I want some extra boost.
/Mattias
Posted by SLS on August 7, 2009, at 9:38:33
In reply to Re: Popular Antidepressants: How They Stack Up » SLS, posted by tensor on August 7, 2009, at 8:51:04
> > What dosages of Remeron have you used, and what were the results?
> >
> > Thanks.
> >
> >
> > - Scott
>
> First time it helped me I took 30mg, the response was massive, the remission was 100%. After a year I went down to maintenance dose of 15mg. I have been up to 60mg but without any further benefits. I'm now on 45mg and I'm starting to get some energy back finally, although it's the first day on 45mg, I stepped up yesterday from 30mg. It may be that 30mg is enough but I want some extra boost.Thanks for the reply.
I hope you get back your 100% remission. What a gift it is to be without depression. The world becomes a very different place to live in.
- Scott
Posted by Sigismund on August 7, 2009, at 16:04:00
In reply to Re: Popular Antidepressants: How They Stack Up, posted by bulldog2 on August 6, 2009, at 14:42:14
>Docs now receive most of their pharmacuetical education from well dressed pharm reps selling a product they get a commission to sell.
Not all. Mine don't. But you have to look around.
Posted by Sigismund on August 7, 2009, at 16:13:37
In reply to Re: Popular Antidepressants: How They Stack Up, posted by Alexanderfromdenmark on August 6, 2009, at 7:41:28
>Why not mirtazapine?
Morgan has me confused. Was mirtazepine the least effective?
I only took it once at a dose of 7.5mg. No way could I be convinced that to take 45mg of that stuff would be good for me.
If it works for you or anyone else, that's great.
The doctor who prescribed it asked me what I had wrong apart from bad sleep? 'Stale promontory?' A week later I realised he was talking about sex.
I wonder if agomelatine does what mirtazepine does without the side effects?
Posted by SLS on August 7, 2009, at 16:29:09
In reply to Re: Popular Antidepressants: How They Stack Up » Alexanderfromdenmark, posted by Sigismund on August 7, 2009, at 16:13:37
> I wonder if agomelatine does what mirtazepine does without the side effects?
I think the blocking of NE alpha2 receptors by mirtazapine sets the two drugs apart. What I don't know is at what dosages the different effects of mirtazapine become robust. I think one might need to take 45mg in order for the pro-noradrenergic effects to become prominent. This might explain why higher dosages are less sedating than lower dosages.
Maybe the NE alpha2 blockade is not necessary for some people. Then, as you say, agomelatine might represent the better choice.
- Scott
Posted by Alexanderfromdenmark on August 7, 2009, at 19:13:16
In reply to Re: Popular Antidepressants: How They Stack Up » Alexanderfromdenmark, posted by Sigismund on August 7, 2009, at 16:13:37
> >Why not mirtazapine?
>
> Morgan has me confused. Was mirtazepine the least effective?
> I only took it once at a dose of 7.5mg. No way could I be convinced that to take 45mg of that stuff would be good for me.
> If it works for you or anyone else, that's great.
> The doctor who prescribed it asked me what I had wrong apart from bad sleep? 'Stale promontory?' A week later I realised he was talking about sex.
> I wonder if agomelatine does what mirtazepine does without the side effects?7.5 mg would be put me in a coma. Apparently with remeron, less is more in terms of sleepiness.
Posted by Sigismund on August 8, 2009, at 0:56:49
In reply to Re: Popular Antidepressants: How They Stack Up, posted by Alexanderfromdenmark on August 7, 2009, at 19:13:16
>7.5 mg would be put me in a coma. Apparently with remeron, less is more in terms of sleepiness.
Well, perhaps there is something in that. But I don't have enough confidence that I would like the result to be prepared to repeat the experiment.
If I had a script for dex (and Valium) I might, but then I wouldn't need to bother.
What has your experience been with Remeron?
Posted by rvanson on August 8, 2009, at 22:58:00
In reply to Re: Popular Antidepressants: How They Stack Up » bulldog2, posted by tensor on August 6, 2009, at 14:48:18
> >The more I talk to doctors the more I realize how poorly they are educated in the area of psychotropic meds.
>
> Sad but true.I agree. Most Pdocs are monotherapists, meaning they don't/won't combine two antidepressants at the same time.
Finding a Pdoc that does prescribe benzos for anxiety is becoming next to impossible and one that will Rx a MAOI is a rare find indeed.
Part of the blame goes to the drug companies who are little more then pushers who twist a molecule to make their stockholders happy while we still suffer. Like always, follow the money.
Posted by rvanson on August 8, 2009, at 23:23:28
In reply to Re: Popular Antidepressants: How They Stack Up » linkadge, posted by tensor on August 7, 2009, at 4:53:25
> > I agree that there is no way that mirtazapine is #1 in efficacy. I have spoken to dozens of psychiatrists both online and in person. None would suggest that mirtazapine has been seriously effective in clinical practice.
> >
> > I've seen so few trials comparing it long term to other agents. I think there is research to suggest it may work faster than SSRI's, but I don't think there is head to head reasearch to suggest it works better long term.
> >
> > I've certainly seen nobody here who has done well on mirtazapine monotherapy.
> >
> > Linkadge
>
> I, on the other hand, know plenty of people who have done great on Remeron only. I'm one example, Remeron worked great for many years until I started using benzos. Remeron was the third AD I tried after earlier treatments with Prozac and Effexor have failed.
>What effect did the benzos cause?
Are you saying that they reversed the anti-depressive responce with Remeron?
Posted by morganpmiller on August 8, 2009, at 23:52:16
In reply to Re: Popular Antidepressants: How They Stack Up » tensor, posted by rvanson on August 8, 2009, at 22:58:00
> > >The more I talk to doctors the more I realize how poorly they are educated in the area of psychotropic meds.
> >
> > Sad but true.
>
> I agree. Most Pdocs are monotherapists, meaning they don't/won't combine two antidepressants at the same time.
>
> Finding a Pdoc that does prescribe benzos for anxiety is becoming next to impossible and one that will Rx a MAOI is a rare find indeed.
>
> Part of the blame goes to the drug companies who are little more then pushers who twist a molecule to make their stockholders happy while
we still suffer. Like always, follow the money.
Where do you live? I have not heard of this drought in doctors that prescribe benzos.
Posted by Sigismund on August 9, 2009, at 2:54:00
In reply to Re: Popular Antidepressants: How They Stack Up, posted by morganpmiller on August 8, 2009, at 23:52:16
>Remeron worked great for many years until I started using benzos.
Interesting, and moreover.....
Benzos (IMO) are (poor) opiate substitutes.
While they are not as pleasurable, I'm sure they are more injurious than opiates taken at a low standard dose (which of course is the problem, given the nature of humans with opiates).
Posted by elanor roosevelt on August 9, 2009, at 16:05:47
In reply to Re: Popular Antidepressants: How They Stack Up, posted by Sigismund on August 6, 2009, at 1:41:54
> I simply cannot bring myself to believe that mirtazepine is the most effective AD.
this seems unbelievable to me but in these studies meds that stupify you into submission come out looking great
>
Posted by Sigismund on August 9, 2009, at 16:32:06
In reply to Re: Popular Antidepressants: How They Stack Up, posted by elanor roosevelt on August 9, 2009, at 16:05:47
>this seems unbelievable to me but in these studies meds that stupify you into submission come out looking great
Maybe that's how ECT works....you are given a crash course in learning that there is no use in complaining?
That would have to be the best thing about it.
Posted by tensor on August 9, 2009, at 18:18:49
In reply to Re: Popular Antidepressants: How They Stack Up, posted by elanor roosevelt on August 9, 2009, at 16:05:47
> > I simply cannot bring myself to believe that mirtazepine is the most effective AD.
> this seems unbelievable to me but in these studies meds that stupify you into submission come out looking great
> >
>
>Obviously many hate Remeron, but none have suggested another AD as the most effective. I certainly hope it isn't because of meds have stupified you. ;-)
/Mattias
Posted by Alexanderfromdenmark on August 10, 2009, at 22:16:33
In reply to Re: Popular Antidepressants: How They Stack Up » elanor roosevelt, posted by tensor on August 9, 2009, at 18:18:49
> > > I simply cannot bring myself to believe that mirtazepine is the most effective AD.
> > this seems unbelievable to me but in these studies meds that stupify you into submission come out looking great
> > >
> >
> >
>
> Obviously many hate Remeron, but none have suggested another AD as the most effective. I certainly hope it isn't because of meds have stupified you. ;-)
>
> /Mattias
I can easily see why Remeron could be the most effective antidepressant compared to the SSRI's.
First of all it makes you sleep! It's neigh impossible to stay sane without sleepIt's reduces cortisol, eg Adrenal output. This may be good or bad. But most depressives are heading for adrenal burnout or are already in it. By reducing adrenal output, it gives the adrenal glands a rest.
It decreases prolactin meaning that it increases sex drive and won't make you temporary or permenantly impotent like SSRI's.
Speaking from a man's perspective, it is pro-testosterone whereas 90% of avaible AD's are Anti-testosterone.
Not good for most men. Espcially depressives.
It increases dopamine in the prefrontal cortex. This is good for some reason.
It increases serotonin, but not by reuptake inhibition, This means that it dosn't lead to lower melatonin and other unhealthy stuff.
It stimulates appetite. This could be good or bad for some people. But I like that wolf-hunger feeling.
Increased NE can result in higher mood, more alertness. Too much can result in irritability and anxiety.
Long--term it looks like a better drug as it won't result in adrenal burnout or hypogonadism where as SSRI's can cause and do cause problems like these.
Posted by morganator on August 10, 2009, at 23:02:44
In reply to Re: Popular Antidepressants: How They Stack Up, posted by Alexanderfromdenmark on August 10, 2009, at 22:16:33
Well you make a damn good argument
Posted by morganator on August 10, 2009, at 23:07:12
In reply to Re: Popular Antidepressants: How They Stack Up, posted by morganator on August 10, 2009, at 23:02:44
Still, I have to wonder what it is that keeps it from actually being that popular. Side effects?? You mentioned some up sides to Mirtazepine relative to SSRIs, what are the downsides?
Posted by Sigismund on August 11, 2009, at 2:09:17
In reply to Re: Popular Antidepressants: How They Stack Up, posted by Alexanderfromdenmark on August 10, 2009, at 22:16:33
No argument there.
I'm glad I'm not in a position to have an informed opinion.
Posted by morganator on August 11, 2009, at 17:29:40
In reply to Re: Popular Antidepressants: How They Stack Up, posted by Alexanderfromdenmark on August 10, 2009, at 22:16:33
Do you or anyone else out there know if mirtazepine at the higher doses used for depression is still as helpful for getting sleep as the lower doses usually prescribed for sleep?
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