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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 41. This is the beginning of the thread.
Posted by Enigma on April 17, 2009, at 17:15:42
I've read so many Remeron threads that my eyes have gone crossed, what I can't believe is that how infrequently people mention how well it works for severe depression.
I'm T.R. Bipolar II with also purely severe depression symptoms. My mania would come back, but I'm also taking Geodon for that. Klonopin as needed for stress and help with sleep, and Topamax to help lose weight I gained with Seroquel. Although the Topamax isn't working this time around (I took it after gaining weight with Zyprexa and this time nada weight loss - I'm livid).
1) So, how well does it work for depression? I just quit Nardil, the only AD that worked for me (partially) out of a bucket load of other AD's.
2) Will it really make me gain more weight? 30->45mg rumor true? The package insert doesn't really backup the weight gain claims.
3) I'm on my whopping 2nd day at 7.5mg and the sedation is horrible... I mean, you lose, 3/4 of a day, including sleep time. After 4 days I'm to move to 15, then call the doctor to move up again I guess.
All I care about is getting close/near to curing/helping my depression issues, do not want another ounce of weight on my body from damn meds, and energy instead of sedation.
Sleeping at night has now been possible since I quit Nardil. It seemed to be the sole cause (maybe the mania too) at very poor sleep.
Thanks in advance.
Posted by sowhysosad on April 17, 2009, at 18:25:16
In reply to Remeron for treatment resistant depression..., posted by Enigma on April 17, 2009, at 17:15:42
Remeron is a triumph of marketing over research. The early research on it was deliberately misleading (the drug company buried any unfavourable research) and there's little evidence it has any effect on serotonin.
I can't see how it can help with treatment-resistant depression much at all. All it does is boosts your norepinephrine a bit and makes you fat and sleepy. In fact, I took it for treatment-resistant depression and it just gave me brain fog and some edginess/anxiety. Did exactly zero for my mood.
As I mentioned elsewhere though, might be worth a shot alongside something like Effexor to help with sleep and some of the Effexor side effects.
Posted by Phillipa on April 17, 2009, at 19:41:21
In reply to Re: Remeron for treatment resistant depression..., posted by sowhysosad on April 17, 2009, at 18:25:16
I took 15mg of remeron for sleep for a month felt nothing at all so ditched it. Phillipa. No weight gain either.
Posted by Sigismund on April 17, 2009, at 19:49:45
In reply to Remeron for treatment resistant depression..., posted by Enigma on April 17, 2009, at 17:15:42
>I'm on my whopping 2nd day at 7.5mg and the sedation is horrible... I mean, you lose, 3/4 of a day, including sleep time.
Yes. The only thing I liked about it was that it made my sleep deeper, but that was nowhere near enough to make it worthwhile.
Posted by raisinb on April 17, 2009, at 20:19:30
In reply to Remeron for treatment resistant depression..., posted by Enigma on April 17, 2009, at 17:15:42
Remeron didn't work for me. I think it made my depression worse. But I remember posting about it, and people did mention that it had helped them.
It certainly does make you sleep. And it made me gain 7 pounds in three weeks! For me this was a good thing since I'd lost too much weight from depression.
I discontinued it after a few weeks because I was getting so much worse emotionally.
Posted by sowhysosad on April 17, 2009, at 20:34:50
In reply to Re: Remeron for treatment resistant depression... » Enigma, posted by raisinb on April 17, 2009, at 20:19:30
Purely anecdotal evidence I know, but interesting how none of us found Remeron helpful so far!
A friend in Scotland's been taking it for a few weeks and has found no benefit either.
Posted by Sigismund on April 17, 2009, at 20:48:54
In reply to Re: Remeron for treatment resistant depression..., posted by sowhysosad on April 17, 2009, at 20:34:50
I imagine that the 5ht2c antagonism is of some use but is buried under all the other effects you don't want.
Posted by Enigma on April 17, 2009, at 21:01:41
In reply to Re: Remeron for treatment resistant depression..., posted by Sigismund on April 17, 2009, at 19:49:45
> >I'm on my whopping 2nd day at 7.5mg and the sedation is horrible... I mean, you lose, 3/4 of a day, including sleep time.
>
> Yes. The only thing I liked about it was that it made my sleep deeper, but that was nowhere near enough to make it worthwhile.Thank you all for the responses.
Now here is where I completely lose my mind.
Prequel:
After a large number of setbacks today, I finally found 5 mins of solace from my depression for the day. I had my pc w/winamp playing my favorite tunes, something I can't even bring myself to do because I'm usually too depressed, got my guitar amp and plugged a decent mic into it and belted out(sang) some tunes to some songs I know most of the words to (I know about downloading lyrics, karaoke, etc).. So, then I come back here.
I wanted off of Nardil because I couldn't stand the side-effects anymore. The insomnia, sleep disturbance (waking up over and over again at night), liver damage, MAOI issues, frequent urination, sweating, the list goes on. I get them all. I've been on off Nardil 4 times now all for over 3-8 months. Back to the Selegeline I guess, even though on a functionality scale from 1-10, 10 being best, it works at about a 3-4 at the highest dose for me, then quickly poops out.The doc was all for the change from Nardil.
I forget if I had written down remeron or he mentioned it.. He was all for the change. He admitted he was never comfortable with me taking Nardil in the first place (since he has no exp with Nardil).
Like I said, I'm way overweight from seroquel and the way it looks, I'm going to have to LOSE most of this summer because the weight isn't coming off, and I look like I swallowed a basketball. NOTHING I've tried has taken any of the weight off. There also NO even weight distribution. When I was 22, I was ripped. 6 pack abs, the works.. (40 now) I had abs for 15 years straight. Now I look like Homer Simpson with hair. My last doc did this to me with Zyprexa... added 40 pounds in a heart beat. Took 3x longer to take it off, even with Topamax helping. This time, Topamax aint doing squat and I HATE the way I look.. *I MEAN HATE*. I WILL NOT TAKE MY SHIRT OFF IN PUBLIC. I've been thin/toned all my life. Until the last 2 years and these damned meds.
Now he wants me to start a drug where I can finally sleep - no duh, I could sleep once I dropped the Nardil - WHICH I TOLD HIM BEFORE GETTING REMERON - and its going to add pounds again too?
Sadly, he's one of the best doctors around here. There's no one else. My previous doc who had to quit (changed careers in a sense) wouldn't have done things too much differently.
SSRI do not work for me
TRIC turn me into a raging lunatic - no lie (quite lucky no one got hurt)
A couple other AD's almost made me kill myself.
You name it, I've probably tried it. I have a 2 page long list.
ECT (twice - not 2 times, 2 ROUNDS (bilateral - 10 times each) at 2 hospitals)
VNS - can't afford - success rate WAY to low for me
IBS? - can't afford
Magnetic thing - can't afford - low success rate from what I hear.After stopping Nardil (tapering) I cried a lot, and I'm not a crier). But it stopped. Unfortunately I was still really depressed. I didn't want, and still don't want to do anything but log onto this pc (well, I don't even want to do that) and sleep. Also, got a dui a month ago. Hint: Don't drink w/even 2 beers with Geodon. It's instantly becomes around 4 beers, there are other behaviors you won't like either. Obviously, don't drink on any of these meds...
So just when I though there may be some light at the end of the tunnel, it looks now like the light it out. All I see now are a load a closed tunnels.
I'm sick of this game. Been playing for 10 years easy.
I don't want to play anymore.
Posted by Zana on April 17, 2009, at 21:38:09
In reply to Re: Remeron for treatment resistant depression..., posted by Enigma on April 17, 2009, at 21:01:41
I know how you feel having been on the med not so merry-go-round for 20 years. I bombed out on every AD known to man but have been getting some relief from Pristiq. Effexor was terrible, Pristiq seems to be helping so far.
I am also on Remeron for sleep. Did nothing for my depression but is a great sleep aid. My pdoc wants me off it since she thinks it is causing anxiety. I want off the seroquel since I think it is the culprit. We'll see. I haven't gained weight on the seroquel yet but I stuff myself full of vegetables to avoid stuffing myself full of real food.
Don't give up hope. There's a new combination of something that will help. Get a psychopharm consult, new eyes... Do you have a therapist, someone you can really talk to? I really understand feeling like a depressed life is not worth living. Keep fighting, when you can, to get help.
And let us know how it goes.Zana
Posted by Sigismund on April 17, 2009, at 21:49:33
In reply to Re: Remeron for treatment resistant depression..., posted by Enigma on April 17, 2009, at 21:01:41
Why would you give up Nardil because of the side effects to take up Remeron?
At least Nardil works.
Agomelatine would, I imagine, do everything Remeron does?? (when it comes to a place near you)
Posted by johnj1 on April 17, 2009, at 22:09:46
In reply to Remeron for treatment resistant depression..., posted by Enigma on April 17, 2009, at 17:15:42
I agree with what everyone is saying. I was on it for 3 years and it ruined any enjoyment for me. It makes OCD worse, causes anxiety, and gives you SPONGE BRAIN. Why did I stay on it? Sleep, and I was stupid to stay on it. Withdrawal is hell too. For me, it was a horrible, horrible drug. Why can't you stay on Nardil and try a tca for sleep? Something like trmimipramine or doxepin. Low doses may do the trick.
Posted by sowhysosad on April 17, 2009, at 22:43:58
In reply to Re: Remeron for treatment resistant depression..., posted by Zana on April 17, 2009, at 21:38:09
> I am also on Remeron for sleep. Did nothing for my depression but is a great sleep aid. My pdoc wants me off it since she thinks it is causing anxiety.
She might have a point. The norepinephrine boost might be responsible.
Posted by sowhysosad on April 17, 2009, at 22:47:46
In reply to Re: Remeron for treatment resistant depression..., posted by johnj1 on April 17, 2009, at 22:09:46
> I agree with what everyone is saying. I was on it for 3 years and it ruined any enjoyment for me. It makes OCD worse, causes anxiety, and gives you SPONGE BRAIN. Why did I stay on it? Sleep, and I was stupid to stay on it. Withdrawal is hell too. For me, it was a horrible, horrible drug.
I agree wholeheartedly, and I was alarmed to read in another thread that UK pdocs are routinely giving this crap to severely depressed hospitalised patients.
Why give them a poorly-researched, ineffective glorified antihistamine when there are MAOI's?!
Posted by desolationrower on April 18, 2009, at 1:14:20
In reply to Remeron for treatment resistant depression..., posted by Enigma on April 17, 2009, at 17:15:42
you might try yohimbe instead...
-d/r
Posted by manic666 on April 18, 2009, at 4:56:19
In reply to Re: Remeron for treatment resistant depression..., posted by sowhysosad on April 17, 2009, at 22:47:46
remeron, take it at night if you want to sleep it does work that way , but the weight gain is to rapid , i said no way i mean even if you eat healthy you wont win,
Posted by linkadge on April 18, 2009, at 8:04:07
In reply to Re: Remeron for treatment resistant depression..., posted by manic666 on April 18, 2009, at 4:56:19
I do know people for whom the drug has apparently worked. I think it can help in cases where depression is associated with severe insomnia or weight loss.
Nevertheless it did not help me and (as above) probably did make my depression worse. It made me really sad and listless. It made me feel like things just went on for ever.
Linkadge
Posted by Enigma on April 18, 2009, at 11:13:27
In reply to Re: Remeron for treatment resistant depression..., posted by Zana on April 17, 2009, at 21:38:09
> I know how you feel having been on the med not so merry-go-round for 20 years. I bombed out on every AD known to man but have been getting some relief from Pristiq. Effexor was terrible, Pristiq seems to be helping so far.
> I am also on Remeron for sleep. Did nothing for my depression but is a great sleep aid. My pdoc wants me off it since she thinks it is causing anxiety. I want off the seroquel since I think it is the culprit. We'll see. I haven't gained weight on the seroquel yet but I stuff myself full of vegetables to avoid stuffing myself full of real food.
> Don't give up hope. There's a new combination of something that will help. Get a psychopharm consult, new eyes... Do you have a therapist, someone you can really talk to? I really understand feeling like a depressed life is not worth living. Keep fighting, when you can, to get help.
> And let us know how it goes.
>
> ZanaPristiq eh, I looked that one up after seeing it on a pen at the doc's office and man, talk a about a swooping list of side-effects. It's almost as bad as an MAOI. It doesn't to be mixed with a large with of rx and otc meds either. That one reminds me of Cymbalta, that sent me flying off to the E.R. (suicide watch). Must be really expensive to0 and I'm right near my Medicare coverage gap, so even if I wasn't terrified to take it, I couldn't afford it anyway.
I guess my doc could sample me for a while since it's so new. I don't know. I'm done with the whole lab rate thing.No therapist right now. They don't help me much. I feel like they talk to me like I'm a 5 year old. No thanks.
>I really understand feeling like a depressed life is not worth living.
Nothing is worth this. If I wouldn't leave my family in poverty, I would have nuked myself long ago. I have no blood-family in this country that I care about, nothing binds me here. Already lost the job and friends years ago. I'm a timebomb ticking away. Each day I get closer to flipping a same-sided coin and just calling it out for amusement sake. Game over man.
Posted by Enigma on April 18, 2009, at 11:18:34
In reply to Re: Remeron for treatment resistant depression... » Enigma, posted by Sigismund on April 17, 2009, at 21:49:33
> Why would you give up Nardil because of the side effects to take up Remeron?
>
> At least Nardil works.
>
> Agomelatine would, I imagine, do everything Remeron does?? (when it comes to a place near you)Because I couldn't stand the side-effects of Nardil anymore.. like not being able to sleep... that was a big one. AND, the doc said Remeron (I asked) would be just as good as an AD as Nardil.
Nardil only worked as a 5/10 as an AD anyway. NO AD every got be back to normal or even close.
Posted by johnj1 on April 18, 2009, at 21:26:01
In reply to Re: Remeron for treatment resistant depression..., posted by sowhysosad on April 17, 2009, at 22:47:46
Probably because it knocks them out and makes them easier to deal with. Remeron also made me angry a lot. I remember blowing up so many times over nothing.
Posted by sowhysosad on April 19, 2009, at 10:22:53
In reply to Re: Remeron for treatment resistant depression..., posted by johnj1 on April 18, 2009, at 21:26:01
> Remeron also made me angry a lot. I remember blowing up so many times over nothing.
That's a really common experience too. Elevated adenaline could be to blame, but it could be that people just get grumpy and frustrated from being in a constant mental haze!
Posted by johnj1 on April 19, 2009, at 18:01:12
In reply to Re: Remeron for treatment resistant depression..., posted by sowhysosad on April 19, 2009, at 10:22:53
Yeah, could be. I have a short fuse but remeron made it much worse in a way I can't describe. I broke the visor mirror in the car punching the ceiling. I don't do stuff like that. My wife almost left me. That experience has made me gun shy of meds.
Posted by theo on April 19, 2009, at 22:24:28
In reply to Remeron for treatment resistant depression..., posted by Enigma on April 17, 2009, at 17:15:42
Just curious, I might start Remeron, do you take name brand or generic?
Posted by Enigma on April 19, 2009, at 22:48:05
In reply to Re: Remeron for treatment resistant depression... » Enigma, posted by theo on April 19, 2009, at 22:24:28
> Just curious, I might start Remeron, do you take name brand or generic?
I was taking the generic. I lasted all of one day and ran back to Nardil.
I'm not suicidal anymore.
I may not be able to sleep anymore either, but being suicidal is MUCH worse
Posted by sowhysosad on April 21, 2009, at 19:49:33
In reply to Re: Remeron for treatment resistant depression..., posted by Enigma on April 19, 2009, at 22:48:05
Disappointingly, my friend who was on Remeron has decided not to try any more meds after her negative experience with it, and may never achieve full remission as a result.
I'm really angry with her pdoc. Some years ago she tried fluoxetine and imipramine, had no success and lots of side effects so gave up. So I was pleased to hear she'd decided, reluctantly, to give meds another shot.
Under the UK guidelines, docs are meant to try one of the tried-and-tested SSRI's first - fluoxetine, citalopram or sertraline. Then they can try mirtazapine (Remeron) or Effexor, then a TCA, reboxetine, moclobemide, dosulepin, AD combos, lithium augmentation or phenelzine for more stubborn cases.
With SSRI's all being very different, there was a good chance that citalopram or sertraline would have worked where fluoxetine failed. But for some reason he decided to start her off on Cymbalta.
Now I know a lot of people have a good response to it, but in the UK the national guidelines discourage docs from using it. Pooled data suggests it's less reliable than the older SSRI's and has a higher incidence of side effects. So the decision to start her on Cymbalta was unconventional to say the least. Lily must have bought him a really nice dinner. And gave him a free pen.
I think it was really unprofessional - given that my friend was VERY anti-meds to start off with - to start her off on a drug that guidelines say is less likely to work and may be more unpleasant to take! How did he expect to achieve compliance?
Then the Remeron was the final nail in the coffin - the heavy sedation, mental fog and binge eating were too much to bear. I just don't think its extreme side effects make it a good candidate for someone who's not comfortable with taking meds in the first place.
Docs are also meant to take into account Remeron's propensity for weight gain before prescribing it, so why give it to someone who already had a weight problem?
So there's another soul completely lost to psychiatry who'll probably never get well, all thanks to this idiot's irresponsible behaviour.
Posted by Enigma on April 22, 2009, at 9:17:22
In reply to Remeron's now put my friend off meds for life..., posted by sowhysosad on April 21, 2009, at 19:49:33
Wow, that's really sad. You can't explain to her that other meds have either very few side effects in comparison, and some may have none (for her). ?
I myself, suffer from every side-effect a drug has. I'm pretty much cursed that way.I'm actually extremely upset with my doc for jumping both feet first towards the Remeron approach and SO QUICK to take me off Nardil.
As soon I was a week off of Nardil I became suicidal. I told my wife to leave me and find another man to take care of her and kids both romantically and financially as I was just a step away from the grave (drama, I know, but true). I think there were 3 days where I didn't speak to anyone, just cried, and thought of ways to fund my family so I could be 'free', legal and not so legal.
Currently, I'm on social security disability (U.S.). It's not much, but it pays the bills (mostly). My wife can't work because she takes care of EVERYTHING else (she's Superwife!), including our youngest child, which I couldn't do if I wanted to.
Even when suicidal, I still wouldn't leave my family in poverty, so my rule is to make sure they are covered financially in case I bite the bullet (literally). But, after a couple of days of being in the worst pain of my life, I went right back on the Nardil, slowly, and I'm human again. Nardil never gets me to 10/10 perfection, more like 5/10, but it drives away the suicide and super intense depression. I literally cannot live without it and it's the only drug that's ever really worked for me (Had some success with selegiline too) as an AD.Now all my sleep problems are back, but they're better than being suicidal, so I'll take door #1. I have insomnia really bad (again), and usually get up many times at night and usually have problems getting back to sleep. Just for laughs, checked my med chest and found this Valarian root bottle ("Promotes restful sleep"), so the last 2 nights I took a pill. Now, I can't say in just 2 nights whether or not it was this pill or not, but once I finally did make it to sleep, I slept through the entire night, both nights, which is extremely rare for me. So, I'm going to be taking this stuff every night from now on, hoping that's what's really keeping me asleep. Now if I could just tackle the insomnia.
Again, sorry about your friend. In the past 15+ years, I've been let down my meds and doctors more times than I can count, but you have to get past it in order to feel better. That's what your friend has to focus on. If I don't like a med, I research a new one. If I don't like a doctor, I research a new one. Simple as that. Sometimes you win, sometimes you fail. I seem to fail a lot more than I win. And finally, whatever doesn't kill you, just weakens your organs and damages your body overall. :(
> Disappointingly, my friend who was on Remeron has decided not to try any more meds after her negative experience with it, and may never achieve full remission as a result.
>
> I'm really angry with her pdoc. Some years ago she tried fluoxetine and imipramine, had no success and lots of side effects so gave up. So I was pleased to hear she'd decided, reluctantly, to give meds another shot.
>
> Under the UK guidelines, docs are meant to try one of the tried-and-tested SSRI's first - fluoxetine, citalopram or sertraline. Then they can try mirtazapine (Remeron) or Effexor, then a TCA, reboxetine, moclobemide, dosulepin, AD combos, lithium augmentation or phenelzine for more stubborn cases.
>
> With SSRI's all being very different, there was a good chance that citalopram or sertraline would have worked where fluoxetine failed. But for some reason he decided to start her off on Cymbalta.
>
> Now I know a lot of people have a good response to it, but in the UK the national guidelines discourage docs from using it. Pooled data suggests it's less reliable than the older SSRI's and has a higher incidence of side effects. So the decision to start her on Cymbalta was unconventional to say the least. Lily must have bought him a really nice dinner. And gave him a free pen.
>
> I think it was really unprofessional - given that my friend was VERY anti-meds to start off with - to start her off on a drug that guidelines say is less likely to work and may be more unpleasant to take! How did he expect to achieve compliance?
>
> Then the Remeron was the final nail in the coffin - the heavy sedation, mental fog and binge eating were too much to bear. I just don't think its extreme side effects make it a good candidate for someone who's not comfortable with taking meds in the first place.
>
> Docs are also meant to take into account Remeron's propensity for weight gain before prescribing it, so why give it to someone who already had a weight problem?
>
> So there's another soul completely lost to psychiatry who'll probably never get well, all thanks to this idiot's irresponsible behaviour.
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