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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by cole on January 4, 2001, at 0:09:50
Hello All.
I'm currently on my second round of depression tx with remeron, and it seems to have gradually stopped working over the past month or so. Remeron worked great over the summer. I went off it for about a month, then started the current trial at the end of September. I am presently fighting a serious resurgence of depression and anxiety-- even feeling suicidal at times. My pdoc and I discussed upping my dose-- I was at 45, will be trying 60 (it was what worked the 1st time). She wants me to also take 10mg of ritalin daily because I have found that it is the only thing that gives me motivation to study when I am this depressed. Here's the strange thing- the appetite problem from remeron has tapered off along with the positive effects. Has anyone had a similar experience? Did it get better? The ritalin will help keep me out of bed but it has no effect on my mood, and it forces me to take small amounts of trazodone(< 50mg) to get to sleep. Any ideas? Thanks!
cole
Posted by Dwight on January 4, 2001, at 1:02:43
In reply to Remeron Poop-out?, posted by cole on January 4, 2001, at 0:09:50
Just a thought: The ritalin might be interfering with the antidepressant action of the remeron. Were you taking ritalin the first time you tried remeron?
> Hello All.
> I'm currently on my second round of depression tx with remeron, and it seems to have gradually stopped working over the past month or so. Remeron worked great over the summer. I went off it for about a month, then started the current trial at the end of September. I am presently fighting a serious resurgence of depression and anxiety-- even feeling suicidal at times. My pdoc and I discussed upping my dose-- I was at 45, will be trying 60 (it was what worked the 1st time). She wants me to also take 10mg of ritalin daily because I have found that it is the only thing that gives me motivation to study when I am this depressed. Here's the strange thing- the appetite problem from remeron has tapered off along with the positive effects. Has anyone had a similar experience? Did it get better? The ritalin will help keep me out of bed but it has no effect on my mood, and it forces me to take small amounts of trazodone(< 50mg) to get to sleep. Any ideas? Thanks!
> cole
Posted by SLS on January 4, 2001, at 7:17:06
In reply to Remeron Poop-out?, posted by cole on January 4, 2001, at 0:09:50
> Hello All.
> I'm currently on my second round of depression tx with remeron, and it seems to have gradually stopped working over the past month or so. Remeron worked great over the summer. I went off it for about a month, then started the current trial at the end of September. I am presently fighting a serious resurgence of depression and anxiety-- even feeling suicidal at times. My pdoc and I discussed upping my dose-- I was at 45, will be trying 60 (it was what worked the 1st time). She wants me to also take 10mg of ritalin daily because I have found that it is the only thing that gives me motivation to study when I am this depressed. Here's the strange thing- the appetite problem from remeron has tapered off along with the positive effects. Has anyone had a similar experience? Did it get better? The ritalin will help keep me out of bed but it has no effect on my mood, and it forces me to take small amounts of trazodone(< 50mg) to get to sleep. Any ideas? Thanks!
> cole
Hey Cole.The appetite thing you experienced is supposed to be a trait of Remeron. At lower dosages, hunger is increased via H1 histamine receptor blockade. At higher dosages, it is thought that the effects of Remeron to block norepinephrine alpha-2 receptors becomes predominant and lowers appetite. This pattern also occurs with sedation, I believe.
A friendly suggestion: Once you find again a therapy that works, STICK with it. Your depression returned for one of two scenarios. Either you relapsed for not taking Remeron for long enough before discontinuing it, despite your not having a recurrent-type depression, or you have a recurrent-type depression and require continuous treatment indefinitely. It is far too common a story that someone arbitrarily discontinues an effective treatment, only to relapse and remain less responsive to the same medication.
At the very least, in my opinion, you should take an effective antidepressant for 12 - 14 months. If you relapse within the first 4 months after discontinuation, you might as well consider yourself a "lifer".
Good luck.
- Scott
Posted by cole on January 4, 2001, at 11:35:47
In reply to Re: Remeron Poop-out?, posted by SLS on January 4, 2001, at 7:17:06
>
>
> Hey Cole.
>
> The appetite thing you experienced is supposed to be a trait of Remeron. At lower dosages, hunger is increased via H1 histamine receptor blockade. At higher dosages, it is thought that the effects of Remeron to block norepinephrine alpha-2 receptors becomes predominant and lowers appetite. This pattern also occurs with sedation, I believe.
>
> A friendly suggestion: Once you find again a therapy that works, STICK with it. Your depression returned for one of two scenarios. Either you relapsed for not taking Remeron for long enough before discontinuing it, despite your not having a recurrent-type depression, or you have a recurrent-type depression and require continuous treatment indefinitely. It is far too common a story that someone arbitrarily discontinues an effective treatment, only to relapse and remain less responsive to the same medication.
>
> At the very least, in my opinion, you should take an effective antidepressant for 12 - 14 months. If you relapse within the first 4 months after discontinuation, you might as well consider yourself a "lifer".
>
> Good luck.
>
>
> - ScottI recognize the role my discontinuation may have played in this current depression, but it doesn't do much to realize that now. I stopped the remeron for a month to try reboxetine, and found that the rebox didn't do it for me. At 60mg this summer my appetite was completely out of control, although I did only take it for 3 months and perhaps it would have lessened over time then too. I do realize that remeron could be my life saver, but it has stopped working and that is really frightening, since I am either non-responsive or get agitated with the other psych meds. Is there anything that you know of that I can do now, or have I basically painted myself into a corner? Thanks for taking the time to respond.
Posted by cole on January 4, 2001, at 16:37:44
In reply to Re: Remeron Poop-out?, posted by Dwight on January 4, 2001, at 1:02:43
I started the remeron off the 1st time w/o ritalin, then added it when I found it helped me concentrate on my school work. This 2nd time I've been taking ritalin from the start, although I wasn't using it regularly-- only for serious study days and exams. I added it today per my doc's advice-- 5mg this AM and I will be taking another 5mg soon (getting really tired right now). I don't think the ritalin has much of an effect on the remeron, it didn't drop me down this summer when I added it. I think SLS may be correct-- I haven't responded as well this 2nd trial. I also recognize that seasons play a role and I haven't been too good about using my light box. I will be adding the box and exercise, but I wanted to cover the med base as well. Thanks for your response. If you have any other ideas I'm open to suggestions.
cole> Just a thought: The ritalin might be interfering with the antidepressant action of the remeron. Were you taking ritalin the first time you tried remeron?
>
>
>
>
Posted by cole on January 4, 2001, at 16:41:29
In reply to Re: Remeron Poop-out?, posted by cole on January 4, 2001, at 16:37:44
> I started the remeron off the 1st time w/o ritalin, then added it when I found it helped me concentrate on my school work. This 2nd time I've been taking ritalin from the start, although I wasn't using it regularly-- only for serious study days and exams. I added it today per my doc's advice-- 5mg this AM and I will be taking another 5mg soon (getting really tired right now). I don't think the ritalin has much of an effect on the remeron, it didn't drop me down this summer when I added it. I think SLS may be correct-- I haven't responded as well this 2nd trial. I also recognize that seasons play a role and I haven't been too good about using my light box. I will be adding the box and exercise, but I wanted to cover the med base as well. Thanks for your response. If you have any other ideas I'm open to suggestions.
> cole
>
> > Just a thought: The ritalin might be interfering with the antidepressant action of the remeron. Were you taking ritalin the first time you tried remeron?
> >
> >
> >
> >
Posted by SLS on January 4, 2001, at 21:30:03
In reply to Re: Remeron Poop-out? » SLS, posted by cole on January 4, 2001, at 11:35:47
> > A friendly suggestion: Once you find again a therapy that works, STICK with it. Your depression returned for one of two scenarios. Either you relapsed for not taking Remeron for long enough before discontinuing it, despite your not having a recurrent-type depression, or you have a recurrent-type depression and require continuous treatment indefinitely. It is far too common a story that someone arbitrarily discontinues an effective treatment, only to relapse and remain less responsive to the same medication.
> I recognize the role my discontinuation may have played in this current depression,
How were you to know? Not your fault.
> but it doesn't do much to realize that now.
Of course it does. I'm sure your future decisions will take this experience into consideration. Smart.
> I stopped the remeron for a month to try reboxetine, and found that the rebox didn't do it for me. At 60mg this summer my appetite was completely out of control, although I did only take it for 3 months and perhaps it would have lessened over time then too. I do realize that remeron could be my life saver, but it has stopped working and that is really frightening, since I am either non-responsive or get agitated with the other psych meds.
I think 75mg of Remeron would turn your appetite around.
> Is there anything that you know of that I can do now,
There's a ton of stuff. What I can't think of, dozens of other people on Psycho-Babble will. Two quickies...
The most obvious alternative is to raise your dosage of Remeron to 75mg. Aside from possibly recapturing your antidepressant response to it, you may find your appetite may be reduced. You can then try adding 300mg - 600mg of lithium for a week to ten days to see if that does the trick. If nothing happens by then, you can consider it a fair trial and discontinue it. Very often, lithium augmentation produces results within four days.
I don't know which medications you are unable to tolerate, but Effexor + Remeron is supposed to be a particularly potent combination. It would be helpful to list the drugs and drug combinations you have tried, and what were their effects - good and bad.
I wouldn't want to throw too many ideas at you, but suffice it to say there will be many, many that will be offered to you by people
here. Best to take things one step at a time and look for feedback as you progress logically and prudently through treatment trials.> or have I basically painted myself into a corner?
I am sure that you haven't. However, you may not so quickly forgive yourself for making such a perfectly logical decision that just did not work out in your favor, that is, until you find something else that works. And you will. Then everything will be peachy-keen. :-) I can see myself wanting to try a different medication in the hopes that it will work as well but without the side effects that are an issue with me. Unfortunately, beggars can't be choosers. I still have a tough time accepting this perspective, but from a bird's eye view, I know this to be excruciatingly true for *me*.
> Thanks for taking the time to respond.
What's an hour and a half?
:-) :-)
- Scott
Posted by cole on January 4, 2001, at 23:45:15
In reply to Re: Remeron Poop-out? » cole, posted by SLS on January 4, 2001, at 21:30:03
Scott,
Thanks for the ideas. I took 1 1/2 45mg tabs of remeron last night, and two 5mg doses of ritalin today, and I'm already feeling a bit better. My OChem prof told me today that I won't be ready to take the April MCAT. Although this would have thrown me into an absolute tizzy of depair yesterday (it significantly alters some major plans) I took the news calmly, and went home to figure out how I could deal with the problem. I think that this 2nd trial hasn't been as strong as my 1st, but I might be able to turn it around by keeping to a higher dose, and augmenting with ritalin until my energy picks up again. The appetite is back today, although not as bad as it has been in the past. I'm going to give the increased dosing+ ritalin a week or so to see if I continue to improve, if it doesn't work then I will look at a trial of Lithium. The remeron has maintained me a bit above my lowest possible point even recently, as I usually get extremely suicidal and the thoughts have only been periodic lately.
As for past med exp:
Trazodone: helps w/ sleep, no AD effect
Zoloft:panic attacks, agitation, increased self mutilation (some AD response, but not like remeron)
Celexa: just like zoloft
Prozac:NR
Wellbutrin: complete and utter brain lag, fogginess, no AD response
Serzone: reduced some of the anxiety, but did little else even @ 400mg daily
Ritalin: no mood effect, helps with the lack of energy + motivation
reboxetine: actually seemed to drive me into a deep depression faster than I usually progress w/o medsSo those are the meds I've tried. As I said, I'm feeling a bit optimistic right now being that I am dealing with obstacles a little better today. I will post again if I get better or worse, but I appreciate your advice. I am more than willing to ignore the side effects of remeron if it can keep me functional.
cole
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