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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by lj on May 12, 2000, at 18:51:56
I have been on Remeron 30mg and wellbutrin 150mg for four months now to treat PTSD and major depression. It is still so hard to get up and moving in the morning, especially if i take the remeron after 9pm. my doc said to take it at dinner time...6ish, but then i'm so tired i wantto go to sleep by 8. Has anyone else been on this combination and had similar problems ??
Posted by Andre Allard on May 13, 2000, at 17:30:52
In reply to remeron/wellbutrin, posted by lj on May 12, 2000, at 18:51:56
I am surprised that you are only on 150mg of wellbutrin to treat major depression. Is this low dose helping? About your problem - this is an easy one. If the remeron is making you drowsy then simply reduce the dosage to 15mg. If 15mg is not enough to help with sleep, then maybe a switch over to trazadone could do the trick. I currently take 100mg of traz at night to help with sleep and I luv the stuff. I notice a big difference when I am not taking the traz and when I do. The effexor I take makes my feet agitated and therefore difficult to sleep. The trazadone takes care of this and more. Without it, I am only a partial responder to effexor. It takes away the side effects from the effexor such as agitation, insomnia and a lack of emotion towards anything. Just some suggestions for ya. Good luck!
Posted by allisonm on May 14, 2000, at 18:18:00
In reply to remeron/wellbutrin, posted by lj on May 12, 2000, at 18:51:56
Yes, I've been on Remeron for more than 2 years, Wellbutrin for almost a year. If you're having trouble getting out of the fog, perhaps lowering the Remeron to 15mg and upping the Wellbutrin (300 *I think* is the therapeutic dose). Right now, my Remeron has been lowered from the top dose of 45 down to 30 and now to 15. Meantime, Wellbutrin has been upped from 100 (with 45 Remeron), to 200 (with 30 Remeron) and now to the top dose of 400mg (with 15 Remeron). More energizing. Less fog in the morning. Actually, I usually wake up before the alarm. Your mileage, of course, may vary.
Posted by SLS on May 16, 2000, at 10:46:44
In reply to Re: remeron/wellbutrin, posted by allisonm on May 14, 2000, at 18:18:00
> > I am surprised that you are only on 150mg of wellbutrin to treat major depression. Is this low dose helping? About your problem - this is an easy one. If the remeron is making you drowsy then simply reduce the dosage to 15mg. If 15mg is not enough to help with sleep, then maybe a switch over to trazadone could do the trick. I currently take 100mg of traz at night to help with sleep and I luv the stuff. I notice a big difference when I am not taking the traz and when I do. The effexor I take makes my feet agitated and therefore difficult to sleep. The trazadone takes care of this and more. Without it, I am only a partial responder to effexor. It takes away the side effects from the effexor such as agitation, insomnia and a lack of emotion towards anything. Just some suggestions for ya. Good luck!
> Yes, I've been on Remeron for more than 2 years, Wellbutrin for almost a year. If you're having trouble getting out of the fog, perhaps lowering the Remeron to 15mg and upping the Wellbutrin (300 *I think* is the therapeutic dose). Right now, my Remeron has been lowered from the top dose of 45 down to 30 and now to 15. Meantime, Wellbutrin has been upped from 100 (with 45 Remeron), to 200 (with 30 Remeron) and now to the top dose of 400mg (with 15 Remeron). More energizing. Less fog in the morning. Actually, I usually wake up before the alarm. Your mileage, of course, may vary.
Wellbutrin 150mg/day is often an effective dosage, but some people need as much as 450mg/day (even 600mg/day). It makes sense to try going up to 300mg/day to evaluate how much more you can get out of it. People tend to need less Wellbutrin when they use the SR preparation.
- Scott
Posted by MoBe on August 31, 2002, at 12:58:28
In reply to Re: remeron/wellbutrin, posted by SLS on May 16, 2000, at 10:46:44
> > > I am surprised that you are only on 150mg of wellbutrin to treat major depression. Is this low dose helping? About your problem - this is an easy one. If the remeron is making you drowsy then simply reduce the dosage to 15mg. If 15mg is not enough to help with sleep, then maybe a switch over to trazadone could do the trick. I currently take 100mg of traz at night to help with sleep and I luv the stuff. I notice a big difference when I am not taking the traz and when I do. The effexor I take makes my feet agitated and therefore difficult to sleep. The trazadone takes care of this and more. Without it, I am only a partial responder to effexor. It takes away the side effects from the effexor such as agitation, insomnia and a lack of emotion towards anything. Just some suggestions for ya. Good luck!
>
> > Yes, I've been on Remeron for more than 2 years, Wellbutrin for almost a year. If you're having trouble getting out of the fog, perhaps lowering the Remeron to 15mg and upping the Wellbutrin (300 *I think* is the therapeutic dose). Right now, my Remeron has been lowered from the top dose of 45 down to 30 and now to 15. Meantime, Wellbutrin has been upped from 100 (with 45 Remeron), to 200 (with 30 Remeron) and now to the top dose of 400mg (with 15 Remeron). More energizing. Less fog in the morning. Actually, I usually wake up before the alarm. Your mileage, of course, may vary.
>
> Wellbutrin 150mg/day is often an effective dosage, but some people need as much as 450mg/day (even 600mg/day). It makes sense to try going up to 300mg/day to evaluate how much more you can get out of it. People tend to need less Wellbutrin when they use the SR preparation.
>
>
> - Scott
>
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???
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
Posted by SLS on September 3, 2002, at 20:35:09
In reply to Re: remeron/wellbutrin » MoBe, posted by SLS on September 3, 2002, at 11:19:56
Here's another report of serotonin syndrome associated with Remeron therapy:
- Scott
Posted by petters on September 4, 2002, at 0:19:35
In reply to Re: remeron/wellbutrin, posted by SLS on September 3, 2002, at 20:35:09
Dear Scott!!!
It is always so nice to see your name on the babble. I always hope that you get some relife from the dam.. depression, when you are able to write, on this site.
By the way. I have replaced nefazodon with remeron again. Remeron is mutch better for the lengt of sleep, and the sleep pattern. Especially the deep sleep, which improve my cognitive performance mutch better (I probebly have ADD too)
Futhermore my libido and deleyed ejaculation, are mucth better, than with nefazodon.
My only fear: To get back the reccurent infections, especially sore throut, and sinuit from mirtazapine. Despite normal blood cells etc. When I was off mirtazapine for 8 month I didn´t have any infections att all. On mirtazapine I use to have 4 - 5 infections per year.
Current med: Venlafaxin 300 mg + mirtazapine 30 mg + lamotrigine 300 mg + litium.
Im so sorry. I almost feel ashamed, asking you qestion, about myself, when I feel good and you still suffering.
I will pray for you, and you must have the winning ticket very soon. Belive me. I know how it is to wait and be patient.
Sincerely......//Petters
Posted by SLS on September 4, 2002, at 8:31:11
In reply to Re: remeron/wellbutrin ((((SLS))), posted by petters on September 4, 2002, at 0:19:35
Hi Petters.
> My only fear: To get back the reccurent infections, especially sore throut, and sinuit from mirtazapine. Despite normal blood cells etc. When I was off mirtazapine for 8 month I didn´t have any infections att all. On mirtazapine I use to have 4 - 5 infections per year.
As usual, thanks for the wonderful, although unnecessary flattery.
In Re: Your sore throat
I think the soreness in your throat might be a direct effect of the medication rather than the result of a microbial infection. I suffered something similar with Lamictal the first time I tried taking it. It occurred at dosages of between 100mg - 300mg, and lasted for two months before it disappeared. However, when I returned to it over three years ago, this effect did not reappear. Laboratory blood tests results showed indicated that there was no infection. Endoscopic nose and throat exams showed negative.
Another side effect that became prominent early was moderate dandruff. I began to use a dandruff shampoo containing ZINC pyrithione. I have not stopped using it since. I can't be sure, but I think the sore throat may have resolved at some point after beginning the shampoo treatments. Perhaps there is some association. Oral zinc supplements and zinc lozenges are sometimes used to treat sore throats in the absence of infection. Perhaps both the dandruff and sore throat are related physiologically so as to be amenable to zinc therapy. I don't know to what extent the zinc contained in the shampoo might enter the body transdermally.
I'll post soon regarding the progress of my own treatment. There's still hope.
Thanks again for your concert, Petters.
- Scott
Posted by MoBe on September 4, 2002, at 22:15:17
In reply to Re: remeron/wellbutrin » MoBe, posted by SLS on September 3, 2002, at 11:19:56
> 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).
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11374336&dopt=Abstract
>
>
>
> Here is a case in which Remeron monotherapy was clearly responsible for the induction of serotonin syndrome:
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11918514&dopt=Abstract
>
>
> 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%)
> Hyperpyrexia
>
>
>
> I hope this helps.
>
>
> - ScottDear Scott
Thanks very much for your help. I have actually tried wellbutrin SR 150mg BID. It helped with my ADD but not as much for the depression. When I began 15 mg Remeron the Doctor decreased the wellburin to 150mg. OD. I feel "more up" when I keep the wellbutrin at 150mg and up the remeron to 30 or 45 mg. a day - but then, of course comes the myoclonus. Since this is the only symptom of serotonin syndrome I'm getting I actually tried to treat the symptom with valerian and it worked. However, I have no idea how risky it is to take these three together for an extended period. Thanks for any input.
MoBe
Posted by petters on September 5, 2002, at 0:23:04
In reply to Re: remeron/wellbutrin ((((SLS))) » petters, posted by SLS on September 4, 2002, at 8:31:11
Dear Scott...
I did forgett to ask you one question, if you don´t mind.
Is there some meds that have the same propertis regarding the sleep pattern, that Remeron has for me ? As I wrote Remeron makes my sleep so mutch deeper and improve my cognition to + sexual benefites.
So my qestion is: If I have to replace Remeron, what is the alternative ? I have tried some, H1-antagonist, antihistamine, with mild effect.
Trazodone is not availiable here.When I was on Remeron for tree years, I really had 3 - 4 infections per year. Sinuit, laryngit etc. This was treated with antibiotiks.
Many Thanks in advance
Sincerely...........///// Petters
Posted by Lasagne on June 11, 2003, at 10:32:31
In reply to remeron/wellbutrin, posted by lj on May 12, 2000, at 18:51:56
> I have been on Remeron 30mg and wellbutrin 150mg for four months now to treat PTSD and major depression. It is still so hard to get up and moving in the morning, especially if i take the remeron after 9pm. my doc said to take it at dinner time...6ish, but then i'm so tired i wantto go to sleep by 8. Has anyone else been on this combination and had similar problems ??
reply: My husband just began the Remeron in combination with his 150 mgs of Wellbutrin. The first night (this Monday June 9th) he took Remeron with dinner and was ready to go to bed by 8 p.m.
Last night he decided to take it a bit later but this morning he had a hard time getting moving.
I know other people that have taken Remeron and they say it knocks you out hard. Maybe you can cut one of your pills in half and see how you do on half.
My husand weights about 238 and is 6 foot 1. It makes him sleep well, but I still notice that he gets up to go to the bathroom at night.
He is being treated for depression and ADHD. He also takes slow release Ritalin.
I hope this helps you out.
Posted by Lasagne on June 11, 2003, at 13:10:15
In reply to Re: remeron/wellbutrin, posted by Lasagne on June 11, 2003, at 10:32:31
This is something I found on Psycho-Babble about taking a lower dose of Remeron. Sorry if I mislead you by telling you to possibly try cutting your dose in half. Lasagne
"As you have probably read before, the lower the dose of Remeron, the higher the sedation. This is because the higher the dose, the greater ability Remeron has to raise norepinephrine. At 45 to 60 mg the activating effects of norepinephrine cancel out/overpower the strong anti-histamine/drowsiness effect of Remeron.
15 mg is much more sedating than 30 mg while 45 mg is either not sedating or somewhat sedating, & for many 60 mg is activating. Keep in mind that women may be less sedated at a given dose since the elimination half life of Remeron is longer in females than males."> > I have been on Remeron 30mg and wellbutrin 150mg for four months now to treat PTSD and major depression. It is still so hard to get up and moving in the morning, especially if i take the remeron after 9pm. my doc said to take it at dinner time...6ish, but then i'm so tired i wantto go to sleep by 8. Has anyone else been on this combination and had similar problems ??
>
> reply: My husband just began the Remeron in combination with his 150 mgs of Wellbutrin. The first night (this Monday June 9th) he took Remeron with dinner and was ready to go to bed by 8 p.m.
> Last night he decided to take it a bit later but this morning he had a hard time getting moving.
> I know other people that have taken Remeron and they say it knocks you out hard. Maybe you can cut one of your pills in half and see how you do on half.
> My husand weights about 238 and is 6 foot 1. It makes him sleep well, but I still notice that he gets up to go to the bathroom at night.
> He is being treated for depression and ADHD. He also takes slow release Ritalin.
> I hope this helps you out.
>
Posted by waterfall on June 12, 2003, at 19:44:58
In reply to Re: remeron/wellbutrin, posted by Lasagne on June 11, 2003, at 13:10:15
I've been on this combination for seven years with varying dosages and I found I was REALLY lethargic. Every morning I spent thirty minutes swearing to myself I'd go to bed at eight that night and my most favorite activity was not getting up until I felt like it which meant I slept through half of every weekend. In January my doc added an upper to my regimine - Provigil, which they tend to give to people with MS for more energy. Great stuff to combat the Well/Rem combo. Of course, it means one more drug, too. I'm in the process of trying to get off all three.
This is the end of the thread.
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