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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 28. This is the beginning of the thread.
Posted by michelle41a on October 18, 2010, at 11:51:31
Howdy folks!
My Pdoc wants me to start Remeron for my anxiety and loss of appetite. As some of you may know, I am on 15.625 mg zoloft. I have been on the zoloft for 6 weeks. My question is, do I just stop taking the zoloft today and go right to remeron? Also, I take .5mg klonopin daily..Can I keep taking the klonopin with the remeron?
What would be the best thing to do? I can't stay on the zoloft anymore.. It has made my anxiety worse and I haven't eaten much in 3 days :( I am really scared about doing this switch, but I can't live in this constant state of panic anymore :(
Any info/suggestions are welcome and appreciated!
((HUGS))
Michelle
Posted by Phillipa on October 18, 2010, at 13:05:22
In reply to Going from Zoloft to Remeron I am worried :(, posted by michelle41a on October 18, 2010, at 11:51:31
Michelle sorry it didn't work out for you. How did the doc suggest you make the switch? Phillipa
Posted by michelle41a on October 18, 2010, at 13:15:28
In reply to Re: Going from Zoloft to Remeron I am worried :( » michelle41a, posted by Phillipa on October 18, 2010, at 13:05:22
> Michelle sorry it didn't work out for you. How did the doc suggest you make the switch? Phillipa
He said to not take the zoloft today and just take the remeron.. I am so scared of withdrawal from the zoloft though! He also said I could keep taking the klonopin..I have been on klonopin .5 1x day for 6 weeks now..If I don't need the klonopin anymore, will it be easy to wean off? I am so sorry for all the questions, I am having a horrible anxiety attack right now :( I am so afraid to take the remeron! I was thinking of taking 7.5 of remeron tonight to see how it works..Hopefully it sedates me so I can eat LOL!
Posted by Phillipa on October 18, 2010, at 19:42:12
In reply to Re: Going from Zoloft to Remeron I am worried :(, posted by michelle41a on October 18, 2010, at 13:15:28
If you are that anxious now stay on the klonopin and a test dose of remeron tonight might just ease your worries. Good luck. Phillipa
Posted by morgan miller on October 18, 2010, at 20:26:17
In reply to Going from Zoloft to Remeron I am worried :(, posted by michelle41a on October 18, 2010, at 11:51:31
Sorry you are in such an uncomfortable state. Maybe the suggestion I made to try 25 mg in the morning for a few days is not such a good idea. Hmm..
Why Remeron and not Lexapro? Just because of the appetite issue? What if the lack of appetite is solely due to Zoloft? I really think you should see a good endocrinologist and get all your hormones tested and if they are out of whack, talk about biodynamic hormone replacement therapy. This alone may make you feel a ton better.
By the way, if you try Lexapro, start very low, like 2.5 mg, and stay there for a 3 or 4 weeks before you consider raising the dose.
Posted by Phillipa on October 18, 2010, at 21:12:46
In reply to Re: Going from Zoloft to Remeron I am worried :(, posted by morgan miller on October 18, 2010, at 20:26:17
Morgan has an excellent point. I am currently taking 2.5mg of lexapro with 50mg luvox I'm stuck on:( Phillipa
Posted by michelle41a on October 19, 2010, at 11:38:39
In reply to Re: Going from Zoloft to Remeron I am worried :(, posted by morgan miller on October 18, 2010, at 20:26:17
> Sorry you are in such an uncomfortable state. Maybe the suggestion I made to try 25 mg in the morning for a few days is not such a good idea. Hmm..
>
> Why Remeron and not Lexapro? Just because of the appetite issue? What if the lack of appetite is solely due to Zoloft? I really think you should see a good endocrinologist and get all your hormones tested and if they are out of whack, talk about biodynamic hormone replacement therapy. This alone may make you feel a ton better.
>
> By the way, if you try Lexapro, start very low, like 2.5 mg, and stay there for a 3 or 4 weeks before you consider raising the dose.
>
>What worries me about lexapro is the negative side effects on my GI tract. On July 27th I started Klonopin .5 2x Day. I also started Celexa 2.5mg once a day. The Klonopin started to help me with the panic and I started to eat a bit more. After 2 weeks, I had to cut back the Klonopin to .5 once a day because it was way too sedating.. I was on 2.5 celexa for 3 weeks but I didn't feel like it was doing anything for me..I probably should have given it some more time, but I opted for the zoloft because I was on it before and had success..So I started the Zoloft on Aug 27th. I did notice some improvement in my eating during the second week on zoloft.. From the third week and beyond on zoloft, my anxiety became to increase dramatically..I also started to get the same symptoms that I had when I was on Prozac. Eventually, by the 6th week of zoloft, I was back to not eating again and losing more weight. Yesterday, the anxiety was just as bad as it was in July.
So I called my pdoc and he suggested the Remeron for the weight loss and loss of appetite.
I took 3.5mgs remeron at 9pm last night and I felt really calm. I guess sedated would be a better word but I had absolutely no panic. I slept pretty good and woke up around 11 am. I did feel the usual morning anxiety but I was able to sleep through it. I just ate some cereal and took .0625 klonopin to see how I would react to it. So far so good! I am a bit groggy and slightly woozy/shaky and slightly grumpy but my GI tract is calm and I am not experiencing the panic that I was the past 3 days.. I am going to give the remeron another try tonight and see what happens. My goal is to be able to eat and gain back the 25 lbs I lost and to be calm..
I guess I am a bit hesitant to go back on something like Celexa or Lexapro due to my bad experience with Prozac.
I had my T3,T4 free T3 and T4 checked and they came back normal. I had my hormones checked and my FSH and LH is in the menopausal range. My estradol is at 80. I am going to my gyno thursday to discuss my cyst pain and what hormonal therapy I should be taking. I hope I feel better soon! This constant state of feeling like crap is really annoying :( I also feel like I am coming down with a cold so that is not helping the situation :(
I am wondering if the morning anxiety is due to adrenal issues? I was thinking of taking a saliva cortisol test to see if my cortisol levels are raised in the morning causing the anxiety/rapid heart beat upon waking.
Posted by morgan miller on October 19, 2010, at 20:46:10
In reply to Re: Going from Zoloft to Remeron I am worried :(, posted by michelle41a on October 19, 2010, at 11:38:39
I would get as many tests as possible. The cortisol test is a good one.
It really sounds like you would benefit from HRT.
One of the reasons why they made Lexapro was because of the greatly reduced amount of side effects. The other reason was because it simply worked better. I think it is worth a shot. Hopefully if you have any GI issues they will be fairly mild and will go away after 3 or 4 weeks. The thing with SSRIs is you really have to give them quite some time before you can determine if the side effects with go away and the therapeutic benefit will be realized.
Sorry your dealing with this, it really S U C K S!
Posted by linkadge on October 21, 2010, at 20:04:36
In reply to Going from Zoloft to Remeron I am worried :(, posted by michelle41a on October 18, 2010, at 11:51:31
I had problems on 15.625mg of zoloft too. So, I lowered it to 15.624mg and everything worked out great!
Linkadge
Posted by linkadge on October 21, 2010, at 20:13:43
In reply to Re: Going from Zoloft to Remeron I am worried :(, posted by morgan miller on October 19, 2010, at 20:46:10
>One of the reasons why they made Lexapro was >because of the greatly reduced amount of side >effects.
They didn't really "make" lexapro. Escitalopram has been around for about 25 years as a metabolite of citalopram. It was not "designed" to have less side effects, this is simply the result of having less drug in your system. Some people have more side effects (i.e. anxiety, activation) with escitalpram vs. citalopram.
>The other reason was because it simply worked >better.
This is a matter of debate. All of the studies suggesting superiority of escitalopram were funded by lundbeck when citalopram came off patent. If the theory regarding citalopram is true, it would have more serotonergic side effects, due to absence of the metabolite which counteracts serotonergic effects.
Posted by morgan miller on October 21, 2010, at 23:28:41
In reply to Re: Going from Zoloft to Remeron I am worried :(, posted by linkadge on October 21, 2010, at 20:13:43
> >One of the reasons why they made Lexapro was >because of the greatly reduced amount of side >effects.
>
> They didn't really "make" lexapro. Escitalopram has been around for about 25 years as a metabolite of citalopram. It was not "designed" to have less side effects, this is simply the result of having less drug in your system. Some people have more side effects (i.e. anxiety, activation) with escitalpram vs. citalopram.Thanks for the correction, Encyclopedia Brown of Psychiatric Medication. I actually knew that, my bad for not explaining it exactly.
> >The other reason was because it simply worked >better.
>
> This is a matter of debate. All of the studies suggesting superiority of escitalopram were funded by lundbeck when citalopram came off patent. If the theory regarding citalopram is true, it would have more serotonergic side effects, due to absence of the metabolite which counteracts serotonergic effects.
>This is true that Lexapro may not be much better than Celexa for many people. But the reality is that they are different enough that some with notice a significant difference between the two. As with everything, all you have to do is read enough reports of people doing better on Lexapro to start to get the idea that there is a good chance Lexapro is better than Celexa. I like to look at real world experiences. This may not be a very scientific approach, but if you read enough from the right sources, and pay attention to what is going on with the people you talk to in person(friends, co-workers, etc.) that have taken Lexapro and Celexa, you will start to get an idea of what is going on with these drugs.
What's going on with you Linkage? Your previous post to Michelle about reducing Zoloft was unnecessary. I understood your point and I saw the humor in it, but come on man, you don't have to be rude and obnoxious about it.
Posted by linkadge on October 22, 2010, at 6:54:12
In reply to Re: Going from Zoloft to Remeron I am worried :(, posted by morgan miller on October 21, 2010, at 23:28:41
>As with everything, all you have to do is read >enough reports of people doing better on Lexapro >to start to get the idea that there is a good >chance Lexapro is better than Celexa.
Sure...for those people in whom it works better. Keep in mind, many patients would simply never switch to lexapro if citalopram were working fine.
>you will start to get an idea of what is going >on with these drugs.
I'd love to believe that your pool of friends and family constitutes even a fraction of one percent of the people who have tried both drugs. According to the following meta analysis, "the manufacturer's claims of superiority for escitalopram over citalopram are unwarranted". Unless you are going to perform a larger meta-analysis, I'm going to maintain my opinions.
http://www.ncbi.nlm.nih.gov/pubmed/14665791
>What's going on with you Linkage?
Trying to pull the old "why are you acting like this?" routine, I see. I think (before asking what is wrong) you first need to clearly establish that there is something wrong, other than your own personal incompatability with my ways.
Linkadge
Posted by michelle41a on October 22, 2010, at 11:15:34
In reply to Re: Going from Zoloft to Remeron I am worried :(, posted by linkadge on October 22, 2010, at 6:54:12
> >As with everything, all you have to do is read >enough reports of people doing better on Lexapro >to start to get the idea that there is a good >chance Lexapro is better than Celexa.
>
> Sure...for those people in whom it works better. Keep in mind, many patients would simply never switch to lexapro if citalopram were working fine.
>
> >you will start to get an idea of what is going >on with these drugs.
>
> I'd love to believe that your pool of friends and family constitutes even a fraction of one percent of the people who have tried both drugs. According to the following meta analysis, "the manufacturer's claims of superiority for escitalopram over citalopram are unwarranted". Unless you are going to perform a larger meta-analysis, I'm going to maintain my opinions.
>
> http://www.ncbi.nlm.nih.gov/pubmed/14665791
>
> >What's going on with you Linkage?
>
> Trying to pull the old "why are you acting like this?" routine, I see. I think (before asking what is wrong) you first need to clearly establish that there is something wrong, other than your own personal incompatability with my ways.
>
> Linkadge
>
>Hi everyone!
Just wanted to give you an update on my experience with Remeron.
Yesterday was day 4 of remeron. I stopped the zoloft the first day I took the remeron (Per doc's suggestion)
I feel much calmer during the day but I do still get the morning groggy feeling. The extreme morning anxiety (racing heart, sweating, panic along with loose bm) has subsided quite a bit. I still am dealing with the loose bm episodes in the morning, but it is only in the morning. I still have feelings of weirdness but I am hoping that will subside as well.
As you know I have been on .5 klonopin daily (I take .125 chunks when I feel anxious) I am still wondering if I should keep the daily dose of .5 for now. My biggest fear of klonopin is possibly lowering the dose and having withdrawls. I have only been on klonopin for 2 months so I guess I may not have to worry about that.
I apologize for my ignorance to the dosing of klonopin, it is a new med for me. Also, adjusting to the remeron is scary but getting better. I guess all I can do is try to go about my daily activities as best as I can while dealing with the med change from zoloft to remeron. I am also dealing with an ovarian cyst which has been causing me some mild pain. I went to my gyno yesterday and he scheduled another ultrasound to see if the cyst has become larger. I am hoping to avoid surgery because my anxiety could not handle it right now. Another concern is my 20lb weight loss from the anxiety. I was assured by my gyno that being 5'8 and 110 lbs was not life threatening for someone with a small frame structure. But when you suffer from panic/GAD it still can bother you.. I try not to look in the mirror because it scares me that I look so thin! I was really thin (115 lbs) before my start with ssri's 10 years ago, I guess I became used to being 25 lbs over my "normal" weight. I want to thank everyone for their continued support and advise during all of this.
((HUGS))
Michelle
Posted by ed_uk2010 on October 22, 2010, at 13:48:39
In reply to Re: Going from Zoloft to Remeron I am worried :(, posted by linkadge on October 22, 2010, at 6:54:12
Everyone is constantly being told that Lexapro is better than citalopram. The result of this is that people report better results with it. The psychological effects of believing that you are on a superior product are very strong.
I am now on Lexapro instead of citalopram. I do seem to be feeling better, but I cannot prove that this is due to the switch. I will stay on it anyway.
Just as an aside, escitalopram is not a metabolite of citalopram, it is one of citalopram's optical isomers. A 20mg tablet of citalopram (Celexa) contains two forms of citalopram: 10mg of escitalopram and 10mg of R-citalopram.
Posted by linkadge on October 22, 2010, at 14:51:30
In reply to Re: Going from Zoloft to Remeron I am worried :( » linkadge, posted by ed_uk2010 on October 22, 2010, at 13:48:39
>Just as an aside, escitalopram is not a >metabolite of citalopram, it is one of >citalopram's optical isomers. A 20mg tablet of >citalopram (Celexa) contains two forms of >citalopram: 10mg of escitalopram and 10mg of R->citalopram.
Yes. However, a person who is on citalopram is technically on escitalopram + rcitalopram?
Linkadge
Posted by linkadge on October 22, 2010, at 14:54:15
In reply to Re: Going from Zoloft to Remeron I am worried :( » ed_uk2010, posted by linkadge on October 22, 2010, at 14:51:30
I think I remember reading that the majority of citaloprams sigma agonism is in the r isomer, thus escitalopram would not be as potent a sigma agonist? Also isn't citalopram more potent at 5-ht2c and histamine h1? These properties could produce some theraputic effect.
Linkadge
Posted by ed_uk2010 on October 22, 2010, at 16:46:55
In reply to Re: Going from Zoloft to Remeron I am worried :( » ed_uk2010, posted by linkadge on October 22, 2010, at 14:51:30
Hi Link,
>a person who is on citalopram is technically on escitalopram + R-citalopram?
That is correct. Citalopram (Celexa), like several commonly used drugs, consists of two different versions of the molecule. Citalopram (Celexa) contains 50% S-citalopram (also called escitalopram) and 50% R-citalopram. The R-citalopram molecule is like the mirror image of S-citalopram (escitalopram).
So yes, if someone takes 20mg of Celexa, they are getting 10mg of escitalopram (as contained in Lexapro) but also 10mg of R-citalopram
Posted by ed_uk2010 on October 22, 2010, at 16:57:28
In reply to Re: Going from Zoloft to Remeron I am worried :(, posted by linkadge on October 22, 2010, at 14:54:15
>I think I remember reading that the majority of citaloprams sigma agonism is in the r isomer, thus escitalopram would not be as potent a sigma agonist? Also isn't citalopram more potent at 5-ht2c and histamine h1? These properties could produce some theraputic effect.
Since Lexapro is patent-protected but Celexa is off-patent, there are very good reasons for Lundbeck to promote the alleged superiority of Lexapro. The trials presented by Lundbeck suggest that Lexapro is slightly more effective than Celexa and also somewhat better tolerated than other SSRIs. To what extent this is true will only become clear when we see independent evidence. At the moment, the appealing diagrams presented on the Lexapro website are IMO pseudoscience.
My personal experience with Lexapro so far has been positive. I do not know how much of this is due to psychological reasons. I started Lexapro with the attitute that 'it might be better and it certainly shouldn't be worse'... so there could be some placebo effect going on. Many people on babble are quick to assert that such psychological factors do not influence them, particularly with regard to discussion of generics. I think this is very unwise.
Posted by morgan miller on October 22, 2010, at 19:48:06
In reply to Re: Going from Zoloft to Remeron I am worried :( » linkadge, posted by ed_uk2010 on October 22, 2010, at 16:57:28
> Many people on babble are quick to assert that such psychological factors do not influence them, particularly with regard to discussion of generics. I think this is very unwise.
I am one of those. I never went into starting a generic with any knowledge that there was a possibility that the brand could be better. The way I see it, no expectations = no placebo. I actually was excited about not having to pay as much, which you would think would contribute to a positive placebo effect, it didn't. I went on Celexa thinking I would do better on it as it may not have been as stimulating as Lexapro. I gave it a good month thinking that it was going to be better for me. After a month, I realized that I felt slightly better on Lexapro and had less side effects. Look, I know we can't trust the studies done by Lundbeck and I understand why there is controversy over whether Lexapro really is better than Celexa, but all you have to do is know that there is enough of a difference between the two to possibly make a difference with some people. Even if Lexapro is only better for 20 percent of the people that try it and Celexa, that is enough to consider it to be worth trying if Celexa has not given you quite the results you need.
Posted by Phillipa on October 22, 2010, at 20:05:00
In reply to Re: Going from Zoloft to Remeron I am worried :(, posted by morgan miller on October 22, 2010, at 19:48:06
Seriously celexa at 20mg taken for a month whiped me out so tired. Where at that same time or close to it lexapro stimulated me so must be a difference. Now don't feel it? Phillipa
Posted by morgan miller on October 22, 2010, at 20:10:05
In reply to Re: Going from Zoloft to Remeron I am worried :(, posted by linkadge on October 22, 2010, at 6:54:12
>>What's going on with you Linkage?
>Trying to pull the old "why are you acting like this?" routine, I see. I think (before asking what is wrong) you first need to clearly establish that there is something wrong, other than your own personal incompatability with my ways.
Ha ha, yeah stupid question, there is always something going on with you, and the rest of us that feel the need to come here to seek answers and better treatment.
Actually, I am incompatible with with SOME of your ways, that's one of the things makes this world interesting, everyone is different and everyone is compatible with everyone's ways. I simply thought that you were a bit out of line poking fun a someone who is just on here getting better. I found it a bit juvenile that's all.
Posted by morgan miller on October 22, 2010, at 20:11:06
In reply to Re: Going from Zoloft to Remeron I am worried :(, posted by michelle41a on October 22, 2010, at 11:15:34
Good luck with Remeron, Michelle, hope it works out for you.
Posted by Phillipa on October 22, 2010, at 21:30:06
In reply to Re: Going from Zoloft to Remeron I am worried :( » michelle41a, posted by morgan miller on October 22, 2010, at 20:11:06
Michelle how did today go? Phillipa
Posted by ed_uk2010 on October 23, 2010, at 16:51:09
In reply to Re: Going from Zoloft to Remeron I am worried :(, posted by morgan miller on October 22, 2010, at 19:48:06
>The way I see it, no expectations = no placebo.
I wouldn't say so. Whenever a person is aware of a change in their medication, there is the potential for psychological factors to become involved in their treatment response (or what they perceive to be their treatment response).
With regard to differences between brands and generics, if differences occured only due to physical reasons (which is not the case), we would see a similar number of people reporting that they prefered the generic to the brand as people who reported that they prefered the brand to the generic. This is because generics could be more bioavailable and not less bioavailable.
Posted by morgan miller on October 24, 2010, at 6:47:04
In reply to Re: Going from Zoloft to Remeron I am worried :( » morgan miller, posted by ed_uk2010 on October 23, 2010, at 16:51:09
Hey I hear ya and completely understand the reasoning. All I know is, I experienced a difference. I was consumed with a full time job and school. I was excited to pay less money. I had plenty going on with my life to keep me distracted and worked out 6 days a week. Still, I did not feel the same. Sure it may have been that the generic caused stomach upset for whatever reason and I felt more anxiety because of that. Whatever was going on, I felt worse on sertraline generic. Again, I follow your logic, but some very intelligent experienced psychiatrists that I have been in contact with believe there is a difference for a part of the population, and they do not think it is mainly due to placebo. Something's going on here.
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