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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by mogger on March 26, 2012, at 11:35:27
Just out of curiosity does any input as to whether buspar or remeron have a more powerful effect on squeezing serotonin? I notice remeron does not have any serotonin reuptake inhibitor properties (per wikipedia) but wonder which of the two most likely cause serotonin syndrome if combined with 5htp or Tryptophan?
mogger
Posted by SLS on March 26, 2012, at 12:22:35
In reply to is buspar or remeron more powerful on serotonin?, posted by mogger on March 26, 2012, at 11:35:27
> Just out of curiosity does any input as to whether buspar or remeron have a more powerful effect on squeezing serotonin? I notice remeron does not have any serotonin reuptake inhibitor properties (per wikipedia) but wonder which of the two most likely cause serotonin syndrome if combined with 5htp or Tryptophan?
>
> mogger
There are several anecdotal reports on Medline/Pubmed describing serotonin syndrome involving a combination of a SRI and mirtazapine. You should be able to find a few.
- Scott
Posted by mogger on March 26, 2012, at 12:28:37
In reply to Re: is buspar or remeron more powerful on serotonin? » mogger, posted by SLS on March 26, 2012, at 12:22:35
Thanks Scott. It is interesting as I checked medscape.com and I did an interaction checker with mirtazapine and zoloft and then buspar and zoloft separately and the interaction between buspar and zoloft was (serious: use alternative) and the interaction between zoloft and remeron was (moderate: monitor closely). Both these interactions stated that there was increase in serotonin but I am not sure why the buspar and zoloft interaction is more significant.
Posted by Phillipa on March 26, 2012, at 12:50:04
In reply to Re: is buspar or remeron more powerful on serotonin? » SLS, posted by mogger on March 26, 2012, at 12:28:37
Why do so many pdocs combine remeron with SSRI's then? Is it the dose? Phillipa
Posted by SLS on March 26, 2012, at 13:10:19
In reply to Re: is buspar or remeron more powerful on serotonin? » SLS, posted by mogger on March 26, 2012, at 12:28:37
> Thanks Scott. It is interesting as I checked medscape.com and I did an interaction checker with mirtazapine and zoloft and then buspar and zoloft separately and the interaction between buspar and zoloft was (serious: use alternative) and the interaction between zoloft and remeron was (moderate: monitor closely). Both these interactions stated that there was increase in serotonin but I am not sure why the buspar and zoloft interaction is more significant.
I believe this warning regarding a Buspar and Zoloft combination is based upon theory - and a rather flawed one. The concern revolves around the ability for Buspar to act to partially stimulate serotonin 5-HT1a receptors. Combining 5-HT reuptake inhibition and 5-HT1a receptor partial agonism is precisely what Viibryd is all about. Viibryd has not yet demonstrated a propensity to produce serotonin syndrome. Buspar is often chosen to augment serotonergic drugs. If it were so dangerous to do this, we would have seen more of it. Actually, Buspar has its own "safety valve" to prevent overstimulation. It not only acts on postsynaptic receptors, but on presynaptic autoreceptors as well. I think of Buspar as being more of a serotonin modulator than a stimulator.
- Scott
Posted by mogger on March 26, 2012, at 13:12:24
In reply to Re: is buspar or remeron more powerful on serotonin? » mogger, posted by SLS on March 26, 2012, at 13:10:19
Awesome Scott thanks for your expertise.
Joseph
Posted by phidippus on March 26, 2012, at 19:56:07
In reply to is buspar or remeron more powerful on serotonin?, posted by mogger on March 26, 2012, at 11:35:27
Remeron is a power tetracyclic seratonin reuptake inhibitor. There is no comparison between Remeron and Buspar, which is weak seratonin agonist.
Eric
Posted by SLS on March 26, 2012, at 20:27:28
In reply to Re: is buspar or remeron more powerful on serotonin? » mogger, posted by phidippus on March 26, 2012, at 19:56:07
> Remeron is a power tetracyclic seratonin reuptake inhibitor.
Is there any chance that you are confusing drugs? I have never seen anything describing serotonin reuptake inhibition being associated with Remeron. I will say that you have taught me things in the past about the more recent discoveries regarding drug mechanisms. Perhaps this is one of them?
- Scott
Posted by phidippus on March 28, 2012, at 17:51:12
In reply to Re: is buspar or remeron more powerful on serotonin? » phidippus, posted by SLS on March 26, 2012, at 20:27:28
Mirtazapine (Remeron, Avanza, Zispin, Miro) is a tetracyclic antidepressant (TeCA) used primarily in the treatment of depression.
from: http://en.wikipedia.org/wiki/Mirtazapine
Eric
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