Posted by SLS on September 3, 2002, at 11:19:56
In reply to Re: remeron/wellbutrin » SLS, posted by MoBe on August 31, 2002, at 12:58:28
Hi MoBe.
> Regarding Remeron and Wellbutrin combination- for the last couple of months I have been on 15 mg Remeron and 150 mg wellbutrin. This does wonders for my insomnia and my ADD but doesn't quite lift the depression well enough. I don't seem to have any side effects on this dose - but when I increase either (in order to lift the depression) I end up getting myoclonus (the muscle jerking). I'm wondering if this is part of serotonin syndrome ie. is it dangerous. It usually subsides in about an hour but it's fairly bothersome for that hour.Has anyone had their psychdoc comment on those symptoms???
Generally, I don't think one would think of serotonin syndrome as a consequence of combining these two drugs. However, there are almost always idiosyncratic events or paradoxical reactions associated with almost any psychotropic drug. Wellbutrin is not well understood, and I have seen abstracts on Medline that postulate that it will increase serotonin (5-HT) activity via its action on norepinephrine (NE).
Here is a case in which Remeron monotherapy was clearly responsible for the induction of serotonin syndrome:
Taken together, both of these abstracts yield in my mind the possibility that serotonin syndrome might be a rare adverse interaction between Wellbutrin and Remeron.For depression, it is usually not advisable to evaluate the effectiveness of Wellbutrin until reaching 300mg. Perhaps it is worth discontinuing Remeron in favor of another strategy to treat insomnia. There are many.
The symptoms of serotonin syndrome include the following:
Mental status changes
Confusion (51%)
Agitation (34%)
Hypomania (21%)
Anxiety (15%)
Coma (29%)Cardiovascular
Sinus tachycardia (36%)
Hypertension (35%)
Hypotension (15%)Gastrointestinal
Nausea (23%)
Diarrhea (8%)
Abdominal pain (4%)
Salivation (2%)Motor Abnormalities
Myoclonus (58%)
Hyperreflexia (52%)
Muscle rigidity (51%)
Restlessness (48%)
Tremor (43%)
Ataxia/incoordination (40%)
Shivering (26%)
Nystagmus (15%)
Seizures (12%)Other
Diaphoresis (45%)
Unreactive pupils (20%)
Tachypnea (26%)
HyperpyrexiaI hope this helps.
- Scott
poster:SLS
thread:33306
URL: http://www.dr-bob.org/babble/20020829/msgs/118661.html