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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by mogger on March 12, 2012, at 13:16:53
Can anyone explain why a lower dose of Remeron causes more sedation? I am at 45mg and my pdoc would like me to go to 30mg as he thinks I will sleep better and that 30mg can be just as effective as 45mg for depression. Can that be true as well? Thanks,
mogger
Posted by Phillipa on March 12, 2012, at 16:19:09
In reply to Why does lower dose of Remeron cause more sedation, posted by mogger on March 12, 2012, at 13:16:53
So they say and many have posted of the sedating properties of remeron at especially l5mg. I took once for month and no sedation at 15mg too. Phillipa
Posted by linkadge on March 12, 2012, at 16:43:42
In reply to Why does lower dose of Remeron cause more sedation, posted by mogger on March 12, 2012, at 13:16:53
One theory is that there are two competing actions with remeron, the antihistamine and the alpha-2 adrenergic antagonist (which increases NE release).
Remeron is a stronger antihistamine, so it probably saturates the h1 receptors at lower doses. As the dose increases, the alpha-2 antagonist effect becomes more pronounced. Or so the theory goes.
Linkadge
Posted by mogger on March 12, 2012, at 16:51:26
In reply to Re: Why does lower dose of Remeron cause more sedation, posted by linkadge on March 12, 2012, at 16:43:42
Thanks Linkadge. Would that translate into at a lower dose Remeron works on more Serotonin than at a higher dose working on NE? Also if you don't mind me asking one more question. Do you think that their is a major difference in efficacy between 30 and 45 or can 30 be a good dose for depression as well? Thanks for your help,
mogger
Posted by SLS on March 12, 2012, at 19:40:10
In reply to Re: Why does lower dose of Remeron cause more sedation » linkadge, posted by mogger on March 12, 2012, at 16:51:26
> Thanks Linkadge. Would that translate into at a lower dose Remeron works on more Serotonin than at a higher dose working on NE? Also if you don't mind me asking one more question. Do you think that their is a major difference in efficacy between 30 and 45 or can 30 be a good dose for depression as well? Thanks for your help,
As you can see, I'm not Linkadge. :-) I, too, would like to see what he has to say about the 5-HT receptor interactions of Remeron at different dosages.
From what I can see, Remeron is a habitually underdosed drug when used by psychiatrists to treat depression. In my opinion, the real effective dosage range is more like 45 - 90 mg/day. 15 - 30 mg/day seems to make for a good sleeping pill.
- Scott
Posted by mogger on March 12, 2012, at 19:45:51
In reply to Re: Why does lower dose of Remeron cause more sedation » mogger, posted by SLS on March 12, 2012, at 19:40:10
Thanks Scott! Good to hear from you and I hope you are continuing to improve. I thought this was an interesting excerpt on wikipedia regarding interactions with MAOI's but also that mirtazapine can be used to treat serotonin syndrome! :)
"According to the prescribing information, mirtazapine must not be started within two weeks of any MAOI usage; similarly, MAOIs cannot be administered within two weeks of mirtazapine.[50] Contradictorily, a single study regarding the combination reported that it does not result in any incidence of serotonin-related toxicity.[51] A case report claimed that mirtazapine can be used to treat serotonin syndrome.[52] Mirtazapine in combination with an SSRI, SNRI, or TCA as an augmentation strategy is safe and is often used therapeutically."
Posted by Avenarius on March 12, 2012, at 21:00:04
In reply to Why does lower dose of Remeron cause more sedation, posted by mogger on March 12, 2012, at 13:16:53
http://www.preskorn.com/columns/0003.htmlscroll down a bit for the mirtazapine details.
Posted by linkadge on March 12, 2012, at 22:00:41
In reply to Re: Why does lower dose of Remeron cause more sedation » linkadge, posted by mogger on March 12, 2012, at 16:51:26
>Thanks Linkadge. Would that translate into at a >lower dose Remeron works on more Serotonin than >at a higher dose working on NE?
Roughly speaking yes. The rate at which receptors are occupied by a drug is not directly proportional to the dose. Suppose that for every doubling of dose, half of the remaining receptors are occupied.
So say:
2mg --> 20% h1 and 5% NE-alpha
4mg --> 60$ h1 and 53% NE-alpha
8mg --> 80% h1 and 77% NE-alpha
16mg --> 90% h1 and 89% NE-alphaThis data is made up, but the trend would likely be the same. You can see that as you increase the dose, the NE effect catches up to the h1 blocking effect. Despite the higher affinity for histamine, it becomes easier for the drug to find NE-alpha receptors (as fewer of them are occupied at lower doses). This makes the drug relatively more activating at higher doses.
As far as effectiveness goes, I'm not sure. I've heard of people having sucess on 45 or 60mg when 30 did not work.
It may be worth a try, if you are tolerating 30mg ok.
Linkadge
Posted by linkadge on March 12, 2012, at 22:11:59
In reply to Re: Why does lower dose of Remeron cause more sedation, posted by linkadge on March 12, 2012, at 22:00:41
Like putting two cups of hot coffee (of different temperatures) in a cold room. Although one cup of coffee may be cooler to start, the hotter coffee will cool faster towards room temperature and the the differences in temperatures will become smaller.
So too with a drug with different affinities for different receptors. As the dose increases (time), receptor occupancy will get closer to 100% (room temperature). Although the drug may have higher affinity for one receptor, the drug with less affinity will show the most increase in affinity (cooling) as the dose increases (time progresses).
Linkadge
Posted by SLS on March 13, 2012, at 0:20:52
In reply to Re: Why does lower dose of Remeron cause more sedation, posted by linkadge on March 12, 2012, at 22:11:59
Hey Linkadge!
What's all of this calculus crap?
I am clueless, as I skipped too many calculus lessons in college. At the time, sex took priority. I don't understand the mathematics, but you do a great job of making the net effect understandable to us laymen, although I am going to have to reread your post a few more times.
Thanks.
You have one hell of an intellectual engine situated between you ears. Overall, I think you have me beat. :-)
- Scott
Posted by mogger on March 13, 2012, at 0:36:08
In reply to Re: Why does lower dose of Remeron cause more sedation, posted by linkadge on March 12, 2012, at 22:00:41
I am with you Scott. I have been trying to decipher this information for about 2 hours! :) Thanks for your help Linkadge. I am at 45mg and am thinking about lowering it to 30mg.
This is the end of the thread.
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