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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by rainbowlight on March 15, 2004, at 1:51:10
Do they work differently together then if one were to be dropped? I love Zoloft and would like to try to get rid of my Remeron but am wondering if the good effect I am getting is from the combination of the two. Anyone have any info on this?
Posted by Sad Panda on March 15, 2004, at 2:01:59
In reply to Anyone else on 2 SSRI's?, posted by rainbowlight on March 15, 2004, at 1:51:10
> Do they work differently together then if one were to be dropped? I love Zoloft and would like to try to get rid of my Remeron but am wondering if the good effect I am getting is from the combination of the two. Anyone have any info on this?
>
>Hi Rainbowlight,
Remeron isn't an SSRI. Remeron is called a 'NaSSa' by the marketing men at Organon. It is a potent anti-histamine that gives great sleep & takes care of SSRI's side effects. How much & when are you taking your drugs? Why are you unsatisfied?
Cheers,
Panda.
Posted by rainbowlight on March 15, 2004, at 2:19:36
In reply to Re: Anyone else on 2 SSRI's? » rainbowlight, posted by Sad Panda on March 15, 2004, at 2:01:59
Sorry, forgot about Remeron not being an SSRI. I am Bipolar and take Lamictal, Remeron, Zoloft and Restoril (for sleep). I put on alot of weight when I added the Zoloft to my meds, tried to get off it, feel horrible, now I am back on it. The pdoc and I are not sure whether the Zoloft caused the weight gain or whether it was a delayed weight gain after 6 months of being on the Remeron. I have never tried going off the Remeron to see if it is the culprit of the weight gain. Originally they put me on the Lamictal and Remeron combo when I was in a severe depression. I have been on them for 2 1/2 years. I added the Zoloft (25 to 50 mgs a day) 2 years ago to help with the anxiety, which it has worked wonders for. I just don't feel good at all when I stop taking it.
Posted by EscherDementian on March 15, 2004, at 4:57:06
In reply to Anyone else on 2 SSRI's?, posted by rainbowlight on March 15, 2004, at 1:51:10
>> Do they work differently together then if one were to be dropped? I love Zoloft and would like to try to get rid of my Remeron but am wondering if the good effect I am getting is from the combination of the two. Anyone have any info on this?
>>There is a wonderful thread about your exact question (inc. Zoloft but not Remeron) MONTHS ago- that i proposed myself and by Ames Saint Vie, and attempted, and was VERY usefully contributed to and informed by Larry Hoover...
Unfortunately all my attempts to relocate it in the Dr. Bob search/google have been unsuccessful. I do not remember the exact month/week period. AND perhaps it was on PBpsych? i am usually almost good at keeping my boards and titles straight, but i just couldn't find that thread.Hopefully one of the Dr.Bob staff can find it for us: re: "effects of taking two SSRIs simultaneously", and SSRI Syndrome.
(*sigh* i wish Larry Hoover was still with us).Sincerely,
Escher
Posted by Sad Panda on March 15, 2004, at 6:05:03
In reply to Re: Anyone else on 2 SSRI's? - Panda, posted by rainbowlight on March 15, 2004, at 2:19:36
> Sorry, forgot about Remeron not being an SSRI. I am Bipolar and take Lamictal, Remeron, Zoloft and Restoril (for sleep). I put on alot of weight when I added the Zoloft to my meds, tried to get off it, feel horrible, now I am back on it. The pdoc and I are not sure whether the Zoloft caused the weight gain or whether it was a delayed weight gain after 6 months of being on the Remeron. I have never tried going off the Remeron to see if it is the culprit of the weight gain. Originally they put me on the Lamictal and Remeron combo when I was in a severe depression. I have been on them for 2 1/2 years. I added the Zoloft (25 to 50 mgs a day) 2 years ago to help with the anxiety, which it has worked wonders for. I just don't feel good at all when I stop taking it.
>
>How much of the other meds do you take & when do you take them? I doubt Remeron suddenly put weight on you after 6 months, it causes weight can mostly by increased appetite. Remeron put me to sleep, I found that Restoril doesn't. If Zoloft doesn't agree with you I would try something else, but only after getting up to a large dose of Lamictal as it is supposed to have some AD effects.
Cheers,
Panda.
Posted by Sad Panda on March 15, 2004, at 6:06:06
In reply to Re: Anyone else on 2 SSRI's?, posted by EscherDementian on March 15, 2004, at 4:57:06
> >> Do they work differently together then if one were to be dropped? I love Zoloft and would like to try to get rid of my Remeron but am wondering if the good effect I am getting is from the combination of the two. Anyone have any info on this?
> >>
>
> There is a wonderful thread about your exact question (inc. Zoloft but not Remeron) MONTHS ago- that i proposed myself and by Ames Saint Vie, and attempted, and was VERY usefully contributed to and informed by Larry Hoover...
> Unfortunately all my attempts to relocate it in the Dr. Bob search/google have been unsuccessful. I do not remember the exact month/week period. AND perhaps it was on PBpsych? i am usually almost good at keeping my boards and titles straight, but i just couldn't find that thread.
>
> Hopefully one of the Dr.Bob staff can find it for us: re: "effects of taking two SSRIs simultaneously", and SSRI Syndrome.
> (*sigh* i wish Larry Hoover was still with us).
>
> Sincerely,
> Escher
>
>She isn't taking to SSRI's, so she has no worries about Serotonin Syndrome.
Cheers,
Panda.
Posted by rainbowlight on March 15, 2004, at 16:06:16
In reply to Re: Anyone else on 2 SSRI's? - Panda » rainbowlight, posted by Sad Panda on March 15, 2004, at 6:05:03
I take 150 mgs. Lamictal, 30 Remeron, 25 mgs. Zoloft and 15 mgs. Restoril. The Lamictal I divide the dose between morning and night, the Remeron I take at night, the Zoloft divided between morning and night and the Restoril at night. Unfortunately I have tried LITERALLY every med available that could help with the anxiety.
Posted by gabbix2 on March 15, 2004, at 20:06:52
In reply to Re: Anyone else on 2 SSRI's?, posted by Sad Panda on March 15, 2004, at 6:06:06
Not quite true. Though Remeron is not labelled an SSRI does not mean it doesn't affect Serotonin.
It does, and can when mixed with an SSRI's cause Serotonin Syndrome.Here's a link
Posted by gabbix2 on March 15, 2004, at 20:13:06
In reply to Re: Anyone else on 2 SSRI's?, posted by gabbix2 on March 15, 2004, at 20:06:52
Posted by gabbix2 on March 15, 2004, at 20:30:07
In reply to Re: Anyone else on 2 SSRI's?, posted by EscherDementian on March 15, 2004, at 4:57:06
pssst.. Just cause I like you Escher, and because it might be helpful to you Rainbow Light, here is a link to the thread Escher mentioned.
Posted by rainbowlight on March 16, 2004, at 2:39:38
In reply to Re: Anyone else on 2 SSRI's? » EscherDementian, posted by gabbix2 on March 15, 2004, at 20:30:07
Gabbix2, thank you so much for finding the link to the posts. Very informative! Thanks again.
Posted by Sad Panda on March 16, 2004, at 7:55:16
In reply to Re: Anyone else on 2 SSRI's?, posted by gabbix2 on March 15, 2004, at 20:06:52
> Not quite true. Though Remeron is not labelled an SSRI does not mean it doesn't affect Serotonin.
> It does, and can when mixed with an SSRI's cause Serotonin Syndrome.
>
> Here's a link
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11675850&dopt=Abstract"Serotonin syndrome induced by fluvoxamine and mirtazapine.
Demers JC, Malone M.
Albany College of Pharmacy, NY, USA.
OBJECTIVE: To document a case of serotonin syndrome associated with the combined use of fluvoxamine and mirtazapine, and to discuss the pharmacodynamic and pharmacokinetic interactions that were the likely causes of this potentially serious adverse drug reaction (ADR). CASE SUMMARY: A 26-year-old white woman with a 12-year history of anorexia nervosa was being treated with fluvoxamine. After mirtazapine was added to her therapy, she developed tremors,restlessness, twitching, flushing, diaphoresis, and nausea,symptoms that are consistent with serotonin syndrome. DISCUSSION: The possible causes of this ADR are discussed, including the effects of fluvoxamine and mirtazapine alone, the possible pharmacodynamic and pharmacokinetic interactions of these two drugs, and the patients underlying anorexia nervosa. CONCLUSIONS: An increasing number of drugs that affect serotonin are available and are indicated for various disorders. Since there is a significant likelihood of these agents being prescribed concomitantly, clinicians must be aware of possible interactions that could lead to serotonin syndrome.
Publication Types:
Case ReportsPMID: 11675850 [PubMed - indexed for MEDLINE]"
Hi Gabbix2,I would guess that the poor ladies anorexia was a major factor in this case. Remeron causing Serotonin Syndrome would be incredibly rare. Remeron doesn't block the reuptake of Serotonin, so it isn't an SSRI, it blocks Serotonin from 5-HT2A, 5-HT2C & 5-HT3 receptors which leaves a little more Serotonin for the 5-HT1 group, which is believed to have an antidepressant effect.
Cheers,
Panda.
Posted by Sad Panda on March 16, 2004, at 8:07:01
In reply to Re: Anyone else on 2 SSRI's? - Panda, posted by rainbowlight on March 15, 2004, at 16:06:16
> I take 150 mgs. Lamictal, 30 Remeron, 25 mgs. Zoloft and 15 mgs. Restoril. The Lamictal I divide the dose between morning and night, the Remeron I take at night, the Zoloft divided between morning and night and the Restoril at night. Unfortunately I have tried LITERALLY every med available that could help with the anxiety.
>
>
>Do you take Restoril every night? It would be the first med I would try & get rid of. If Zoloft makes you happy I would keep it regardless of what your weight does. I take Remeron because it helps me sleep & it's one of the few meds for sleep that isn't addictive. Remeron also help with side effects from the Effexor I take.
Cheers,
Panda.
Posted by dave1 on March 16, 2004, at 8:28:24
In reply to Anyone else on 2 SSRI's?, posted by rainbowlight on March 15, 2004, at 1:51:10
Hi,
Someone on my OCD website said she was taking two SSRI's for five years, then had to stop because she got Serotonin Syndrome, so you have to be careful.
Bye,
Dave
Posted by gabbix2 on March 16, 2004, at 18:42:02
In reply to Re: Anyone else on 2 SSRI's? » gabbix2, posted by Sad Panda on March 16, 2004, at 7:55:16
Yeah, I apologize for stating what I did definitively.
The article I read which used the pub med link as reference did say Serotonin syndrome was a possibility when mixing Remeron with an SSRI,
as did several other articles I've read.However, I should know by now that those same
articles say things like Effexor causes weight LOSS in most people and may cause "uncomfortable"
side effects when discontinued. I guess what I'm saying is, they don't delve too deeply..
Posted by Clayton on March 18, 2004, at 22:06:27
In reply to Anyone else on 2 SSRI's?, posted by rainbowlight on March 15, 2004, at 1:51:10
You may well experience a negative change in effect if you drop the Remaron. Remaron and Zoloft work synergitily. Remarom increases the supply of Seratonin (and Norepinephrine) and Zofloft blocks the reuptake of that Seratonin. Eliminate the Remaron and the Zofloft has less Seratonin to act on. This could dramatically affect your mood.
In my case, I take Paxil (anither SSRI) and Remaron. I took the Paxil alone for two years with mediocre results. A new Pdod added Remaron to the mix. Within threee or four days , I started feeling better than I had in decades. I mean, it was the keys to the Kingdom! My mood disorder depression abated by about 90% and my serious and debilbitating case of SAD disappeared...not a single SAD attach since Remaron was introduced into the mix...not even close.
I would would extreme caustion and tritrate down slowly if you are intent on eliminating the Remaron. It may be an important key to your current good results.
Gook Luck!
> Do they work differently together then if one were to be dropped? I love Zoloft and would like to try to get rid of my Remeron but am wondering if the good effect I am getting is from the combination of the two. Anyone have any info on this?
Posted by Sad Panda on March 19, 2004, at 6:44:55
In reply to Re: Anyone else on 2 SSRI's? » Sad Panda, posted by gabbix2 on March 16, 2004, at 18:42:02
> Yeah, I apologize for stating what I did definitively.
> The article I read which used the pub med link as reference did say Serotonin syndrome was a possibility when mixing Remeron with an SSRI,
> as did several other articles I've read.
>
> However, I should know by now that those same
> articles say things like Effexor causes weight LOSS in most people and may cause "uncomfortable"
> side effects when discontinued. I guess what I'm saying is, they don't delve too deeply..
>
>No need to apoligize, you are the correct one. :) I knew it was theoretically possible, I just though it was highly unlikely because Remeron is so weak at increasing Serotonin levels.
The studies you have to watch out for are the drug A vs drug B, the outcomes of those sorts of studies depends mostly on who is sponsoring the study.
Cheers,
Panda.
This is the end of the thread.
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