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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 26. Go back in thread:
Posted by rjlockhart37 on August 24, 2021, at 21:35:42
In reply to Can mirtazapine (Remeron) cause increased anxiety?, posted by Franz on August 24, 2021, at 16:21:55
it could be a short term reaction, but i know nothing about mirtazapine, i know more about fluoxetine
SLS, link could maybe awnser this
Posted by SLS on August 25, 2021, at 3:15:03
In reply to Re: Can mirtazapine (Remeron) cause increased anxiety?, posted by rjlockhart37 on August 24, 2021, at 21:35:42
> it could be a short term reaction, but i know nothing about mirtazapine, i know more about fluoxetine
>
> SLS, link could maybe awnser thisI cannot tolerate alpha-2 adrenergic antagonists. They fool the presynaptic neuron into manufacturing and releasing extra norepinephrine / noradrenaline. My first drug of this type was idozoxan. The NIH was working with it. It was experimental. For the first week, even the slightest amount of conflict stress led to anxiety and heart palpitations. I think this side effect disappeared within a week of starting treatment.
Later, idazoxan exacerbated my baseline depression. I felt monumentally worse, but following the research protocol meant that I had to keep taking it for two months. Of course, I didn't know what I was getting until the blind-breaking at discharge.
- Scott
Posted by undopaminergic on August 25, 2021, at 5:25:29
In reply to Re: Can mirtazapine (Remeron) cause increased anxiety? » rjlockhart37, posted by SLS on August 25, 2021, at 3:15:03
> > it could be a short term reaction, but i know nothing about mirtazapine, i know more about fluoxetine
> >
> > SLS, link could maybe awnser this
>
> I cannot tolerate alpha-2 adrenergic antagonists.I took mirtazapine, and it made me worse, but it is possible this side effect would have subsided with continued treatment.
I prefer alpha2-*agonists* like guanfacine.
-undopaminergic
Posted by SLS on August 25, 2021, at 20:37:21
In reply to Re: Can mirtazapine (Remeron) cause increased anxiety?, posted by undopaminergic on August 25, 2021, at 5:25:29
> > > it could be a short term reaction, but i know nothing about mirtazapine, i know more about fluoxetine
> > > SLS, link could maybe awnser this
> > I cannot tolerate alpha-2 adrenergic antagonists.
> I took mirtazapine, and it made me worse, but it is possible this side effect would have subsided with continued treatment.
> I prefer alpha2-*agonists* like guanfacine.
>
> -undopaminergic
I think that drug is used for ADHD.
- Scott
Posted by undopaminergic on August 26, 2021, at 0:00:45
In reply to Re: Can mirtazapine (Remeron) cause increased anxiety? » undopaminergic, posted by SLS on August 25, 2021, at 20:37:21
> > > > it could be a short term reaction, but i know nothing about mirtazapine, i know more about fluoxetine
>
> > > > SLS, link could maybe awnser this
>
> > > I cannot tolerate alpha-2 adrenergic antagonists.
>
> > I took mirtazapine, and it made me worse, but it is possible this side effect would have subsided with continued treatment.
>
> > I prefer alpha2-*agonists* like guanfacine.
> >
> > -undopaminergic
>
>
> I think that drug is used for ADHD.It was first used as an antihypertensive called Tenex, and later it was re-released as Intuniv for ADHD. I used it for both purposes, but now I can't get a prescription.
-undopaminergic
Posted by SLS on August 26, 2021, at 7:54:03
In reply to Re: Can mirtazapine (Remeron) cause increased anxiety? » SLS, posted by undopaminergic on August 26, 2021, at 0:00:45
UD:
> It was first used as an antihypertensive called Tenex, and later it was re-released as Intuniv for ADHD. I used it for both purposes, but now I can't get a prescription.
Why not?
- Scott
Posted by undopaminergic on August 26, 2021, at 9:46:04
In reply to Re: Can mirtazapine (Remeron) cause increased anxiety? » undopaminergic, posted by SLS on August 26, 2021, at 7:54:03
> UD:
>
> > It was first used as an antihypertensive called Tenex, and later it was re-released as Intuniv for ADHD. I used it for both purposes, but now I can't get a prescription.
>
> Why not?
>Annoying doctor. And I'm at hospital, so they provide me with a doctor without offering a choice.
Actually, I no longer have the same doctor, and I haven't tested the current one with a guanfacine request, but I'm not optimistic. I'm thinking of asking whether we can replace bisoprolol with guanfacine, but the only preparation available is Intuniv, which is not indicated for high pulse/blood pressure (I use bisoprolol for the former). I do have an ADHD diagnosis but they don't take that seriously. Maybe I could argue that guanfacine could counteract the alpha2-adrenoceptor antagonism of antipsychotics.
-undopaminergic
Posted by SLS on August 26, 2021, at 11:33:23
In reply to Re: Can mirtazapine (Remeron) cause increased anxiety? » SLS, posted by undopaminergic on August 26, 2021, at 9:46:04
> > UD:
> >
> > > It was first used as an antihypertensive called Tenex, and later it was re-released as Intuniv for ADHD. I used it for both purposes, but now I can't get a prescription.
> >
> > Why not?
> >
>
> Annoying doctor. And I'm at hospital, so they provide me with a doctor without offering a choice.
>
> Actually, I no longer have the same doctor, and I haven't tested the current one with a guanfacine request, but I'm not optimistic. I'm thinking of asking whether we can replace bisoprolol with guanfacine, but the only preparation available is Intuniv, which is not indicated for high pulse/blood pressure (I use bisoprolol for the former). I do have an ADHD diagnosis but they don't take that seriously. Maybe I could argue that guanfacine could counteract the alpha2-adrenoceptor antagonism of antipsychotics.
>
> -undopaminergicI didn't know that NE-alpha 2 antagonism was a property of APs. Which ones?
- Scott
Posted by undopaminergic on August 26, 2021, at 12:28:48
In reply to Re: Can mirtazapine (Remeron) cause increased anxiety? » undopaminergic, posted by SLS on August 26, 2021, at 11:33:23
> > > UD:
> > >
> > > > It was first used as an antihypertensive called Tenex, and later it was re-released as Intuniv for ADHD. I used it for both purposes, but now I can't get a prescription.
> > >
> > > Why not?
> > >
> >
> > Annoying doctor. And I'm at hospital, so they provide me with a doctor without offering a choice.
> >
> > Actually, I no longer have the same doctor, and I haven't tested the current one with a guanfacine request, but I'm not optimistic. I'm thinking of asking whether we can replace bisoprolol with guanfacine, but the only preparation available is Intuniv, which is not indicated for high pulse/blood pressure (I use bisoprolol for the former). I do have an ADHD diagnosis but they don't take that seriously. Maybe I could argue that guanfacine could counteract the alpha2-adrenoceptor antagonism of antipsychotics.
> >
> > -undopaminergic
>
> I didn't know that NE-alpha 2 antagonism was a property of APs. Which ones?
>Many of the dirty ones, ie. those groping on a plethora of receptors. For example clozapine, quetiapine, and especially asenapine. Now that I checked it out, though, they (except asenapine) seem to have lower affinity for alpha2A than -2B and -2C. It is my understanding that guanfacine is primarily an alpha2A agonist, and that this is the receptor important for working memory.
-undopaminergic
Posted by Jay2112 on August 26, 2021, at 13:33:43
In reply to Re: Can mirtazapine (Remeron) cause increased anxiety? » rjlockhart37, posted by SLS on August 25, 2021, at 3:15:03
> > it could be a short term reaction, but i know nothing about mirtazapine, i know more about fluoxetine
> >
> > SLS, link could maybe awnser this
>
> I cannot tolerate alpha-2 adrenergic antagonists. They fool the presynaptic neuron into manufacturing and releasing extra norepinephrine / noradrenaline.Interesting. I had my first psychotic episode when I first started mirtazapine. But, I think the eventual down regulation of my norepinephrine/beta-adrenergic receptors by very high-dose Effexor, and the extra norepinephrine produced by mirtazapine, really helped my depressive episodes in my experience with BP II. I learned to cap the mania with carbamazepine, small dose propranolol, and risperidone. Oddly, the addition of amphetamine (or pretty much an extended-release version, Vyvanse) has been amazing, and sustained a smooth antidepressant, pro-social effect for over ten years. As well, high dose Lyrica (for an amazing pro-GABAergic effect!!) has kept me balanced, but with a very controllable anti-anxiety and antidepressant effect.
Anyhow...sorry for going off-topic...as usual..lol.
~Jay :)
Posted by SLS on August 26, 2021, at 19:37:42
In reply to Re: Can mirtazapine (Remeron) cause increased anxiety? » SLS, posted by undopaminergic on August 26, 2021, at 12:28:48
UD:
> Many of the dirty ones, ie. those groping on a plethora of receptors. For example clozapine, quetiapine, and especially asenapine. Now that I checked it out, though, they (except asenapine) seem to have lower affinity for alpha2A than -2B and -2C. It is my understanding that guanfacine is primarily an alpha2A agonist, and that this is the receptor important for working memory.
I like asenapine (Saphris). I tried it and it had an unambiguous antidepressant affect. It lasted several weeks - which for me, was impressive. A friend of mine who has schizoaffective disorder (bipolar type), found asenapine to produce a stable antidepressant response with a more or less global improvement, including cognition and memory.Do you have any ideas as to why asenapine would produce such robust cognitive and memory improvements?
Do not pass up asenapine unless you have reason to believe that it would be unsafe. I don't know why asenapine has been so neglected.
- Scott
Posted by SLS on August 26, 2021, at 19:41:00
In reply to Re: Can mirtazapine (Remeron) cause increased anxiety? » SLS, posted by undopaminergic on August 26, 2021, at 12:28:48
Also, asenapine is remarkably free of side effects. Both my friend and I felt that it was pretty clean. I guess that will vary.
Good luck with it.
- Scott
Posted by SLS on August 26, 2021, at 19:44:31
In reply to Re: Can mirtazapine (Remeron) cause increased anxiety? » SLS, posted by Jay2112 on August 26, 2021, at 13:33:43
> > > it could be a short term reaction, but i know nothing about mirtazapine, i know more about fluoxetine
> > >
> > > SLS, link could maybe awnser this
> >
> > I cannot tolerate alpha-2 adrenergic antagonists. They fool the presynaptic neuron into manufacturing and releasing extra norepinephrine / noradrenaline.
>
> Interesting. I had my first psychotic episode when I first started mirtazapine. But, I think the eventual down regulation of my norepinephrine/beta-adrenergic receptors by very high-dose Effexor, and the extra norepinephrine produced by mirtazapine, really helped my depressive episodes in my experience with BP II. I learned to cap the mania with carbamazepine, small dose propranolol, and risperidone. Oddly, the addition of amphetamine (or pretty much an extended-release version, Vyvanse) has been amazing, and sustained a smooth antidepressant, pro-social effect for over ten years. As well, high dose Lyrica (for an amazing pro-GABAergic effect!!) has kept me balanced, but with a very controllable anti-anxiety and antidepressant effect.
>
> Anyhow...sorry for going off-topic...as usual..lol.
>
> ~Jay :)
Jay, that's a remarkable use of tools. Kudos...- Scott
Posted by undopaminergic on August 27, 2021, at 5:14:12
In reply to Re: Can mirtazapine (Remeron) cause increased anxiety? » undopaminergic, posted by SLS on August 26, 2021, at 19:37:42
> UD:
>
> I like asenapine (Saphris). I tried it and it had an unambiguous antidepressant affect. It lasted several weeks - which for me, was impressive. A friend of mine who has schizoaffective disorder (bipolar type), found asenapine to produce a stable antidepressant response with a more or less global improvement, including cognition and memory.
>That is impressive, yes.
> Do you have any ideas as to why asenapine would produce such robust cognitive and memory improvements?
>Serotonin antagonism; 5-HT2A and -2C. Histamine H2-antagonism. Maybe serotonin 5-HT5 and -6. I would say 5-HT7 too, but I've tested that with lurasidone and I noticed no improvement.
> Do not pass up asenapine unless you have reason to believe that it would be unsafe. I don't know why asenapine has been so neglected.
>I addressed that in another message, directed to you; see:
https://www.dr-bob.org/babble/20210723/msgs/1116677.htmlI would appreciate your thoughts on my regimen.
-undopaminergic
Posted by undopaminergic on August 27, 2021, at 5:16:40
In reply to Re: Can mirtazapine (Remeron) cause increased anxiety? » undopaminergic, posted by SLS on August 26, 2021, at 19:41:00
> Also, asenapine is remarkably free of side effects. Both my friend and I felt that it was pretty clean. I guess that will vary.
>That is unexpected and surprising, given how many receptors it hits; you'd expect many side effects.
> Good luck with it.
Thanks.
-undopaminergic
Posted by Franz on August 27, 2021, at 20:31:37
In reply to Can mirtazapine (Remeron) cause increased anxiety?, posted by Franz on August 24, 2021, at 16:21:55
Posted by SLS on August 30, 2021, at 10:52:21
In reply to Re: Can mirtazapine (Remeron) cause increased anxiety? » SLS, posted by undopaminergic on August 27, 2021, at 5:14:12
Hi, A-D.
I haven't had time to reply to your post, but I will soon.
Your illness sounds complicated.
- Scott
Posted by SLS on August 30, 2021, at 10:59:23
In reply to Re: Can mirtazapine (Remeron) cause increased anxiety? » SLS, posted by undopaminergic on August 27, 2021, at 5:14:12
.
Posted by SLS on August 30, 2021, at 22:22:31
In reply to The above post is for:, posted by SLS on August 30, 2021, at 10:59:23
Posted by undopaminergic on August 31, 2021, at 1:11:55
In reply to Dammit. That post was directed to JAY - Sorry (nm), posted by SLS on August 30, 2021, at 22:22:31
I was hoping you meant this:
https://www.dr-bob.org/babble/20210723/msgs/1116677.html-undopaminergic
Posted by SLS on September 1, 2021, at 22:36:43
In reply to Re: Dammit. That post was directed to JAY - Sorry » SLS, posted by undopaminergic on August 31, 2021, at 1:11:55
> I was hoping you meant this:
> https://www.dr-bob.org/babble/20210723/msgs/1116677.html
>
> -undopaminergic
>
I know, U_D. I had wanted to spend time righting a reply to your wonderful post, but I have had little time. It's good that you made it convenient to find.As one recovers from severe depression, do think that memory takes the longest to recover?
- Scott
Posted by undopaminergic on September 2, 2021, at 8:19:38
In reply to Re: Dammit. That post was directed to JAY - Sorry » undopaminergic, posted by SLS on September 1, 2021, at 22:36:43
>
> As one recovers from severe depression, do think that memory takes the longest to recover?
>I do believe that cognitive impairment is harder to treat than low mood. In the beginning, I was very hopeful, but I've come to believe that a cognitive recovery is too much to ask for. Maybe I shouldn't.
-undopaminergic
Posted by Jay2112 on September 2, 2021, at 15:13:14
In reply to Re: Can mirtazapine (Remeron) cause increased anxiety? » Jay2112, posted by SLS on August 26, 2021, at 19:44:31
> Jay, that's a remarkable use of tools. Kudos...
>
>
>
> - ScottThanks Scott! I meant to ask you..do you use any PRN's, like a benzo, or a something for sleeping, etc?
Myself...I am still trying to chomp at the bit, as long as I keep the mood in check, I am a 'tad' better than asymptomatic. I *really* NEED that interpersonal depth, to deeply empathize with people. That can be difficult with being emotionally 'flatlined'.
Thanks so kindly... :)
Jay
Posted by Englishman006! on October 20, 2021, at 11:07:06
In reply to Re: Can mirtazapine (Remeron) cause increased anxiety? » SLS, posted by Jay2112 on September 2, 2021, at 15:13:14
I'm on Mirtazipine for sleep mainly. It gives me tinitus and music which plays over and over in my head, it also kills my sex drive. I take 22mg at night instead of seroquel 25mg. Both give me the munchies.
I've recently moved to England from Australia and they don't like the idea of antipsychotics for sleep. I take dex which is why I need a sleeper. Is there anything else I could take?
Posted by undopaminergic on October 20, 2021, at 11:30:40
In reply to Re: Can mirtazapine (Remeron) cause increased anxiety?, posted by Englishman006! on October 20, 2021, at 11:07:06
> I'm on Mirtazipine for sleep mainly. It gives me tinitus and music which plays over and over in my head, it also kills my sex drive. I take 22mg at night instead of seroquel 25mg. Both give me the munchies.
>
> I've recently moved to England from Australia and they don't like the idea of antipsychotics for sleep. I take dex which is why I need a sleeper. Is there anything else I could take?
>Many people seem to report using trazodone.
My suggestion is the antihistamine cyproheptadine (Periactin).
Mirtazapine disinhibits noradrenaline release, an action that is probably not good for sleep.
-undopaminergic
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