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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by jerseygal1 on July 27, 2011, at 19:23:44
Wondering if anyone has ever made the switch from remeron to trazodone. I've been on remeron for 8 months and it really hasn't helped with anything other than sleep. I'm also taking pristiq, 50 mg., zyprexa, 5 mg. and clonazepam, .5 to 1 mg.. So far, my current cocktail of meds has not worked for my depression/anxiety. I want to see if remeron could be the problem thus the reason for the switch. My pdoc wants me to taper to 15 mg. remeron for one week and add 25 mg. trazodone at the same time. Then, stop the remeron after one week and adjust trazodone as needed up to 100 mg.
Posted by linkadge on July 27, 2011, at 19:37:57
In reply to Switch from remeron to trazodone, posted by jerseygal1 on July 27, 2011, at 19:23:44
I would reduce the zyprexa (to at least 2.5mg).
5mg is too much for depression. Higher doses will likely produce more depression than solve.
Linkadge
Posted by jerseygal1 on July 27, 2011, at 20:07:17
In reply to Re: Switch from remeron to trazodone, posted by linkadge on July 27, 2011, at 19:37:57
That's a good suggestion. Do you know why higher doses are likely to cause more depression rather than help? To augment my AD's, my pdoc had me start at 2.5 mg. then increase to 5 mg. I've been on the 5 mg. for only 11 days.
Posted by linkadge on July 27, 2011, at 20:46:38
In reply to Re: Switch from remeron to trazodone, posted by jerseygal1 on July 27, 2011, at 20:07:17
zyprexa (olanzapine) is an antipsychotic. It is also approved for use as a mood stabilizer in bipolar disorder.
Zyprexa has effects on a variety of neurotransmitters. In low doses it can help depression by reducing anxiety and/or insomnia. However, in higher doses, it blocks dopamine receptors. This produces the anti-manic / antischizophrenic effect, but it can also result in apathy or more depression (since dopamine is a chemical involved in the ability to experience reward and pleasure).
Linakdge
Posted by morgan miller on July 27, 2011, at 23:05:39
In reply to Re: Switch from remeron to trazodone, posted by linkadge on July 27, 2011, at 20:46:38
What dose of remeron are you taking? I know certain doses work better for sleep and others better for depression, either lower or higher, can't remember. Is it possible the remeron dose is not right.
If you aren't doing that great on this cocktail, it might be time to start over. Just another case of polypharmacy not doing jack. I think proper medicaton dosing is more effective than medication stacking. I also think Link is right here to suggest lowering the Zyprexa dose. Sheesh, sometimes pdocs are their patients' worst enemies. WTF is going on here? The guys on M & M talk about how there are so many bad pdocs out there all the time. It's so so true.
Posted by morgan miller on July 27, 2011, at 23:06:37
In reply to Re: Switch from remeron to trazodone, posted by morgan miller on July 27, 2011, at 23:05:39
Trazadone is a bad antidepressant, and an o.k. sleep medication. I would take Link's advice and lower the Zyprexa before you do anything else.
Posted by morgan miller on July 27, 2011, at 23:08:58
In reply to Switch from remeron to trazodone, posted by jerseygal1 on July 27, 2011, at 19:23:44
Low dose lithium may be worth a shot, if you have not tried it already.
Also, are you working out, seeing a therapist, optimizing your diet, taking things like fish oil, magnesium, a good multi, and l methylfolate?
Posted by Phillipa on July 28, 2011, at 0:30:32
In reply to Re: Switch from remeron to trazodone, posted by morgan miller on July 27, 2011, at 23:08:58
Morgan low for sleep higher for ad effect but even the low didn't help me sleep ditched it years ago after a month. Trazadone isn't used much either. Phillipa
Posted by jms600 on July 28, 2011, at 8:45:00
In reply to Switch from remeron to trazodone, posted by jerseygal1 on July 27, 2011, at 19:23:44
I would make changes to your current regime before trying anything else. As linkadge said, drop the dose of Zyprexa that you're taking. I had a real rough time with Zyprexa the last time I took it.
What dose of Remeron are you on? You should consider a higher dose if depression is your main problem. I'd also consider coming off clonazepam completely. When I took clonazepam it really exacerbated my depression. If you do need a benzos for anxiety consider Xanax instead.
Posted by jerseygal1 on July 28, 2011, at 12:17:07
In reply to Switch from remeron to trazodone, posted by jerseygal1 on July 27, 2011, at 19:23:44
Thanks for everyone's input. I think I'm going to try lowering zyprexa back to 2.5 mg. and see what happens. Right now, my problem seems to be a lot of anxiety and obsessive thinking. I was going to stop remeron (30 mg.) to see if it was causing me to feel worse rather than better. I've been on it since Nov. 2010. But, since it's helping me to sleep, that's why I was going to replace it with trazodone. Along with the remeron, I've tried prozac, lexapro and pristiq with no luck. I've been on pristiq 50 mg. about 10 weeks.
Posted by morgan miller on July 28, 2011, at 12:23:30
In reply to Re: Switch from remeron to trazodone » jerseygal1, posted by jms600 on July 28, 2011, at 8:45:00
> I would make changes to your current regime before trying anything else. As linkadge said, drop the dose of Zyprexa that you're taking. I had a real rough time with Zyprexa the last time I took it.
>
> What dose of Remeron are you on? You should consider a higher dose if depression is your main problem. I'd also consider coming off clonazepam completely. When I took clonazepam it really exacerbated my depression. If you do need a benzos for anxiety consider Xanax instead.These are good suggestions. The regimen seems like it needs to be cleaned up. This may take time, and may not be comfortable during the transition, but you may come out feeling much better 6 months down the road. I hate to say this old old cliche, but it's true, "Patience is a virtue". I know I know, easier said than done when suffering.
Posted by morgan miller on July 28, 2011, at 12:26:22
In reply to Re: Switch from remeron to trazodone » morgan miller, posted by Phillipa on July 28, 2011, at 0:30:32
Thanks for straightening that up Phillipa. I thought that was the case.
Posted by linkadge on July 28, 2011, at 20:20:50
In reply to Re: Switch from remeron to trazodone » Phillipa, posted by morgan miller on July 28, 2011, at 12:26:22
I would personally recomend trazodone over remeron (in conjunction with pristiq). The reason being that both pristiq and remeron increase norepeinephrine in a synergistic way. Some people notice irritability and or obsessivness when combining remeron with other noradrenergic drugs.
Even just pristiq and trazodone would be promising IMHO.
Linkadge
Posted by Phillipa on July 28, 2011, at 21:53:11
In reply to Re: Switch from remeron to trazodone » Phillipa, posted by morgan miller on July 28, 2011, at 12:26:22
Glad I could help. For once I did know !!!! Phillipa
Posted by morgan miller on July 29, 2011, at 8:15:28
In reply to Re: Switch from remeron to trazodone, posted by linkadge on July 28, 2011, at 20:20:50
Maybe link is right, the noradrenaline thing would be of some concern. You'll never know if trazadone will work in combo with Pristiq until you try I guess.
Posted by jerseygal1 on July 30, 2011, at 11:25:13
In reply to Re: Switch from remeron to trazodone, posted by linkadge on July 28, 2011, at 20:20:50
The increase in norephinephrine from using both pristiq and remeron is something to think about. I tend to have an obsessive personality to begin with. But I have another question for you guys. I decreased zyprexa from 5 mg. to 2.5 mg. two days ago and I'm feeling very depressed since. Could this be withdrawals from the higher dose? I was only on the higher dose for 11 days.
Posted by markwell on August 1, 2011, at 9:43:31
In reply to Re: Switch from remeron to trazodone, posted by jerseygal1 on July 30, 2011, at 11:25:13
Jerseygirl, is the trazodone helping at all for depression? I'm supposed to be taking 150mgs but it made me too tired. How about for anxiety, any help?
Mark
Posted by jerseygal1 on August 1, 2011, at 12:12:36
In reply to Re: Switch from remeron to trazodone, posted by markwell on August 1, 2011, at 9:43:31
Markwell, I haven't made the switch yet. Is trazodone your only med? Trazodone is known for its sedating side effect. To have an antidepressant effect, you have to take a high dose like yours but it is very sedating. Seems there would be a better med to help you with depression/anxiety. And, if you need traz for sleep, you don't have to go that high on the dose.
Posted by markwell on August 1, 2011, at 12:35:06
In reply to Re: Switch from remeron to trazodone, posted by jerseygal1 on August 1, 2011, at 12:12:36
My pdoc wants me to try it for depression. I'm not sure it's a good ad for major depression. Are u trying it for sleep?
Mark
Posted by jerseygal1 on August 1, 2011, at 16:42:29
In reply to Re: Switch from remeron to trazodone » jerseygal1, posted by markwell on August 1, 2011, at 12:35:06
Yes, I was only going to try it for sleep. My pdoc said I should start at 25 mg., see how it goes, and then could increase to either 50 mg. or 100 mg.
This is the end of the thread.
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