Posted by linkadge on May 29, 2008, at 7:58:11
In reply to Re: The best Tricyclic for anxiety.... » linkadge, posted by torachan on May 28, 2008, at 22:37:34
>This is the drug combo my current doc is >recommending, although he seems to be favoring a >higher does of Seroquel. But I'm a bit confused >here. You said that a 5HT2? blocker would be a >good combination with Effexor, and you included >in your list Remeron along with Seroquel, yet >you said Effexor and Remeron would not be a good >combo for anxiety due to excessive noradrenergic >stimulation.
>Wouldn't a low does of Remeron prevent the >problem you speak of? With Seroquel and me, it's >odd, because I don't seem to have the effects >which most people experience like a single 25mg >dose "knocking them out". I once tested >the "knockout strength" of this drug early in >the trial by taking 350mgs and I was still on my >feet, after being up all night, which Effexor >gives me the tendency to do. Also, I feel a bit >disorientated on Seroquel which scratches at my >edginess, so I'm a little confused as to why if >Remeron and Seroquel are both 5HT blockers, and >with me at least Remeron being a far superior >sleep inducing agent, why would you recommend >against the Rem?
Well, it all depends on how you personally react. Yes remeron is a 5-ht2 blocker but it also has strong effects as a noradrenergic autoreceptor antagonist. Basically, remeron increases the release of norepinephrine. If the dose is low enough this side effect may be negligable (but then too may be the 5-ht antagonist effect).
Some people find that the combination of remeron and effexor very stimulating. The remeron causes a release of norepinephrine and the effexor blocks the reuptake of it.
Its hard to know how you might react. Remeron really helped me sleep on its own, but caused stimulation when combined with effexor. I didn't get that stimulation when REM was combined with a non-noradrenergic drug.
Its not just that the two are noradrenergic, its that they are synergistically noradrenergic.
Nevertheless, if you are going to combine the two, I'd start with a low dose of remeron, (no more than 7.5 or 3.75 (1/4 of a 15mg tab).
>I don't expect you to diagnose me and dispense >with medical advice, just a little informed >opinion. I just seem to trust your opinion and >advice, and will discuss your thoughts, which >have become my thoughts, with my doctor.
I understand. I agree that its not always the best idea to choose drugs based on mechanism, but I have generally found drugs to behave in a manner consistent with what I understand about them.
Seroquel didn't knock me out. 25mg just facilitated sleep.
A number of doctors (especially old school doctors) will use low dose amitryptaline, or doxapin for sleep/anxiety augmentation which can be effective.
Linkadge
poster:linkadge
thread:831465
URL: http://www.dr-bob.org/babble/20080528/msgs/831860.html