![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Greg W on November 6, 1999, at 11:50:36
My Pain Management doctor prescribed Remeron to me for
extreme depression I was having due to the use of Fentanyl
narcotics for back surgery I had over a year ago. He said
it would make me a little drowsy the first 3 or 4 days,
What an understatement!!! The pharmacist says it's more
like 3 or 4 weeks before you get used to it. I'm supposed
to take a tab and a half (45mg), but that much puts me
right to sleep in 15-20 minutes. I took a 1/3 of a tab
at 5pm yesterday, and by 5:30 I was out like a light for
the night. Is this a normal reaction, and will I eventually
get used to it as the pharmacist says? I can only take
Remeron at bedtime and have yet to see any results for
the depression.Many Thanks
Greg
Posted by saint james on November 6, 1999, at 12:49:25
In reply to Remeron and sleep (Lots of it!), posted by Greg W on November 6, 1999, at 11:50:36
> My Pain Management doctor prescribed Remeron to me for
> extreme depression I was having due to the use of Fentanyl
> narcotics for back surgery I had over a year ago. He said
> it would make me a little drowsy the first 3 or 4 days,
> What an understatement!!! The pharmacist says it's more
> like 3 or 4 weeks before you get used to it. I'm supposed
> to take a tab and a half (45mg), but that much puts me
> right to sleep in 15-20 minutes. I took a 1/3 of a tab
> at 5pm yesterday, and by 5:30 I was out like a light for
> the night. Is this a normal reaction, and will I eventually
> get used to it as the pharmacist says? I can only take
> Remeron at bedtime and have yet to see any results for
> the depression.
>
> Many Thanks
> Greg
James here.....So you have 30 mgs tabs and you took 10 mgs last nite ? I take 15 mgs at nite just for sleep, and even though I have taken it for a year or so I still puts me to sleep fast, in the same time you mentioned. With me it took a week b4 the sedation was not so extreme. After that I was not groggy in the morning (after an hour) I would say stay at what you took last nite for a few days till you are not so groggy, then slowly move the dose up. With AD's you will not feel the AD effect for 4 weeks, then it usually comes on slowly over the next month or so. You do need to take enough (45 mgs) the get the AD effects. Remeron is not as sedating at higher doses in many people, and this is common with many sedating Ad's, once they start working and the depression lifts the sedation is less.
j
Posted by allison on November 6, 1999, at 13:35:36
In reply to Re: Remeron and sleep (Lots of it!), posted by saint james on November 6, 1999, at 12:49:25
Greg,
St. James is correct. I'm surprised you were given 45mg at the get-go, though. That's the highest recommended dosage in the US (I think it's 60mg in Europe).
My doctor started me on a smaller dose (15 I think), then increased to 30 and then 45. Recently decreased from 45 to 30 because for me 45 was too sedating -- it hit me within 30 minutes and made me very woosey(sp?) and unsteady on my feet. 30 mgs doesn't affect me so adversely, but still helps me sleep.
As James says, you won't feel the AD effect for weeks. Sometimes I wonder whether it's working at all.
Good luck.
Posted by peterh on November 6, 1999, at 17:13:39
In reply to Re: Remeron and sleep (Lots of it!), posted by allison on November 6, 1999, at 13:35:36
i have ocd and bipolar; am on paxil, smidgen of zyprexa and remeron, now up to 45 and revia for ssri poop out. does anyone have experience of remeron, which to my knowledge ultimately increases intrasynaptic serotonin, with ocd. i am a pure obsessional, without significant compulsive component. also, interested in experiences with r. and appetite at increasing doses. this is a great site. hopefully more people with ocd and other psychiatric brain diseases will post. peace and prosperity to all who suffer. peterh.
Posted by Carol on November 6, 1999, at 18:26:00
In reply to Re: Remeron and sleep (Lots of it!) and OCD, posted by peterh on November 6, 1999, at 17:13:39
peter
Just a quick intrusion, what is the difference between the obsessive and the compulsive part of ocd?Appreciated
carol
Posted by Adam on November 6, 1999, at 19:42:01
In reply to Re: Remeron and sleep (Lots of it!) and OCD , posted by Carol on November 6, 1999, at 18:26:00
I have what is known as an "OCD spectrum disorder", (I was diagnosed by Dr. Judith Rapaport herself while I was
working at the NIH and subsequently got into a study there, so I'm confident of the diganosis) and have exhibited,
on occasion, more "classic" OCD symptoms. I have tried mirtazapine for OCD, at a dose of up to 45mg/day, prescribed
by my pdoc at Mass. General (who works in their OCD clinic, but also has a great amount of experience treating
depression). Mirtazapine was suggested to me while I was in the hospital, as a treatment for both depression and
OCD, and I relayed this info. to my pdoc, who felt it was worth a try. I trust the judgement and expertise of my
current doctors, and feel, like they do, that mirtazapine is not an outlandish choice for the treatment of OCD. The
reason it was suggested (along with traylcypromine, itself not a conventional choice) was that I found the side
effects of SSRIs intolerable (specifically, I put on a ton of weight, and they destroyed my sex life).Unfortunately, I don't think it did much for my illness (though it wasn't entirely ineffective), and it created an
almost intolerable state of somnolence at the highest dose. I felt this effect even after a month at the highest
dose, and after three months on mirtazapine in total. My choices (in relation to dose) seemed to be zombification
or inefficacy. I opted for neither and tried something else.An option that seemes worth trying, to me and to some with actual credentials, is to combine mirtazepine with an SSRI.
This might a) be more efficacious as a combinaition therapy for depression and/or OCD, and b) counteract some or all
of the sexual side effects of the SSRI. I have yet to see or hear a single firsthand account of someone using such an
approach. If you're out there, I would love to hear your story. Did it work as described?The obsessive and compulsive components of OCD are just what they sound like: the disturbing and intrusive thoughts or
images labeled as obsessions and the ritualistic behaviors these obsessions compell the sufferer to engage in. There
are cases in which relentless, disturbing and intrusive thoughts and images are present but do not result in a compulsive
act. This would be OCD without the compulsive component, and would fall under the umbrella of a "spectrum disorder".Hope this helps.
-Adam
Posted by torchgrl on November 6, 1999, at 22:52:29
In reply to Remeron and sleep (Lots of it!), posted by Greg W on November 6, 1999, at 11:50:36
Remeron was BEYOND sedating for me--I remember the first night I took it, I almost couldn't make it from the living room to my bedroom to go to bed, I was so knocked out. When we upped the dose, it got a little better, but I still couldn't tolerate the sedation and the fact that I couldn't stop eating. If you're looking for less sedation, I'd stick with the higher dose! If you can tolerate the side effects, stick it out for awhile--it does usually take several weeks for the AD effect to kick in, regardless of the med.
Posted by Anon E. Mouse on November 7, 1999, at 9:55:52
In reply to Re: Remeron and sleep (Lots of it!) and OCD , posted by Adam on November 6, 1999, at 19:42:01
Hey -
I just started Remeron. As many of you have mentioned, it has made me incredibly tired. Kind of reminds me of having mono. Or sort of like being sick when I was really young. I have only been awake about 4 hours each of the past two days.
Anyway, if the sleepiness lifts soon, I will let you guys know if Remeron works. I am also taking Effexor XR and Buspar.
One nice thing: I rather like having my old appitite back again. On Effexor, I never really had a desire to eat, even though I knew I had to fill my belly.
Also, I've been having all sorts of crazy dreams on Remeron. I'd classify most of them in the nightmare catagory. Isn't this stuff supposed to make me less scared of things?
Posted by peterh on November 7, 1999, at 10:42:49
In reply to Re: Remeron and sleep (Lots of it!) and OCD , posted by Carol on November 6, 1999, at 18:26:00
> peter
>
>
> Just a quick intrusion, what is the difference between the obsessive and the compulsive part of ocd?
>
> Appreciated
> carol
dear carol, how apt. an obsession is an intrusive thought, unwanted and overvalued. a compulsion is supposedly an action based on the obsession. classic forms of ocd include hand washing, checking, religious scrupulosity and other forms of pure obsessions.peace and prosperity to all who suffer. peterh.
Posted by Adam on November 7, 1999, at 17:02:54
In reply to Re: Remeron and sleep (Lots of it!) and OCD , posted by Anon E. Mouse on November 7, 1999, at 9:55:52
I also had extremely vivid dreams while taking mirtazapine. I even would find myself beginning to dream while drifting into
sleep, and would start hearing voices and feeling presences that were not actually there. I even think I may have seen things
that weren't there too. I thought it was fun, but I can see how this would be frightening. OK, this is really embarassing, but
I also started sleepwalking. On one occasion I guess I got up to go pee and didn't quite find the right room. I had to be
informed of this by my horrified roomates. I think the term for the former phenomenon is "hypnagogic hallucinations", and the latter
effect could be due to dysregulation of the reticular activating system (RAS), a portion of the medulla that's supposed to keep us from
from doing goofy things like this while asleep. I first heard about this stuff because my sister was a major sleepwalker until she
hit puberty, and would often experience unusual things while going to sleep or waking up. I never had similar experiences until I
started taking mirtazapine. Since serotonin is involved in regulating the RAS, the combined sedative and serotonergic effects of
maybe brought out a genetic predisposition that was manifested in my sister without drugs.I guess I lucked out in some ways because my dreams were always, um, really pleasurable, and positively cinematic. I would wake up
and just have to say "WOW!", they were that cool.I don't seem to dream at all on selegiline, or if I do, I don't remember them. I do miss the dreams, but not the sedation that went
along with them.
> Hey -
> I just started Remeron. As many of you have mentioned, it has made me incredibly tired. Kind of reminds me of having mono. Or sort of like being sick when I was really young. I have only been awake about 4 hours each of the past two days.
> Anyway, if the sleepiness lifts soon, I will let you guys know if Remeron works. I am also taking Effexor XR and Buspar.
> One nice thing: I rather like having my old appitite back again. On Effexor, I never really had a desire to eat, even though I knew I had to fill my belly.
> Also, I've been having all sorts of crazy dreams on Remeron. I'd classify most of them in the nightmare catagory. Isn't this stuff supposed to make me less scared of things?
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.