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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by JoannaC on March 24, 2004, at 20:46:21
I'm wondering if anyone has been on remeron at a dosage higher than 60 mgs or above. Apparently, I may be wrong, it is supposed to help reduce the weight gain side effect? I don't know if North American Docs are prescibing it this way, but the Europeans are. I'm trying to find research regarding high doses of remeron, and can't find anything. Any information or help, would be greatly appreciated. Thank-you
Posted by Sad Panda on March 24, 2004, at 23:23:14
In reply to Anyone on Remeron dose higher than 60 and above, posted by JoannaC on March 24, 2004, at 20:46:21
> I'm wondering if anyone has been on remeron at a dosage higher than 60 mgs or above. Apparently, I may be wrong, it is supposed to help reduce the weight gain side effect? I don't know if North American Docs are prescibing it this way, but the Europeans are. I'm trying to find research regarding high doses of remeron, and can't find anything. Any information or help, would be greatly appreciated. Thank-you
>
>Higher doses can lower the appetite problem & reduce sedation, but it doesn't always work. What reason are you taking Remeron?
Cheers,
Panda.
Posted by rod on March 25, 2004, at 4:01:17
In reply to Anyone on Remeron dose higher than 60 and above, posted by JoannaC on March 24, 2004, at 20:46:21
My doctor told me he (and his collegues in hospital) prescibes Remeron up to 90mg. Thats the highest dose which makes sense, according to him.
Roland
Posted by rainbowlight on March 25, 2004, at 5:02:03
In reply to Anyone on Remeron dose higher than 60 and above, posted by JoannaC on March 24, 2004, at 20:46:21
45 and above (according to my pdoc) is supposed to be the point where the weight gain is reduced or eliminated. I tried the higher dose but due to severe water retention I couldn't stay on it. I did notice the sedation does go away at the higher doses, and increases at the lower doses.
Posted by JoannaC on March 25, 2004, at 10:45:06
In reply to Anyone on Remeron dose higher than 60 and above, posted by JoannaC on March 24, 2004, at 20:46:21
Sad Panda
I was taking Remeron 15-30 mgs at night for severe unipolar depression. It's the only antidepressant that has ever been effective for me. Unfortunately I gained 45lbs, on top of a 5'2", 110lb frame. I had severe foot, knee and back pain that after a year was intolerable. My pdoc did not give me an option other than going off the remeron. I could not lose a pound while on the remeron, even on a very restricted diet. My pdoc, gp and pharmacist didn't belive me. As soon as I stopped the remeron, within a month, I've lost 20lbs. However I can't sleep, I'm fatigued all the time (Trazodone) gives me all day hangover, Wellbutrin's never helped my depression, racing thoughts coming back, negetive thoughts too, anxiety, and irritabitity. I really need to find a good study to give to my pdoc saying that higher dose of remeron is safe, and will not produce the weight gain side effect. I have to go back on remeron, cuz I'm sliding. My pdoc is 70, and done with researching medications etc... So if I go to him and plead my case he will usually give me the medication. I'm also an Rn with 12 years experience in psychiatric nursing, minus 4 off due to this illness. However I can not find anything on the internet. So if anyone can find a research study about using higher dose remeron in patients, I would be so indebted to you. Thank-you for listening.
Posted by florence on March 25, 2004, at 12:06:04
In reply to Re: Anyone on Remeron dose higher than 60 and above, posted by JoannaC on March 25, 2004, at 10:45:06
I have taken anywhere from 30 to 45 to 60 to 90 mgs remeron. My doc was right: young people hate it becuz it makes them eat, and senior citizens love it becuz it makes them sleep. I stuck with it since I was too depressed and sleep-deprived to care about weight gain. I was taking Provigil (a stimulant) while on remeron and still gained weight becuz I never had an appetite until the evening when the provigil wore off. SO I eat chocolate every single night. I used to detest sweets! Anyway, I never noticd much difference in 30 or 60 mgs in my mood even though I've been reading that 45 or 60 mgs must be used to improve mood and be energizing. So, I've stopped taking it--taken 30 mgs--and now taking 60 mgs becuz I am tired depressed and desperate. I haven't found any hard core evidence about high doses. But I don't remember 90 helping mor than 60. BUT I am 50 yrs old and my female hormones were flip-flopping all over the place. BUT I can't believe I NEVER heard of water/fluid retention being a problem: SO I attributed this to my female problems. Now I AM positive this "fat" feeling is from remeron. So, I just might risk stopping it and trying something else. I wish it helped my mood more but it doesn't. I am also 5'2" and about 140 lbs now and was 120 lbs up until the time I started 30 mgs remeron.
Posted by Sad Panda on March 26, 2004, at 7:14:38
In reply to Re: Anyone on Remeron dose higher than 60 and above, posted by JoannaC on March 25, 2004, at 10:45:06
> Sad Panda
>
> I was taking Remeron 15-30 mgs at night for severe unipolar depression. It's the only antidepressant that has ever been effective for me. Unfortunately I gained 45lbs, on top of a 5'2", 110lb frame. I had severe foot, knee and back pain that after a year was intolerable. My pdoc did not give me an option other than going off the remeron. I could not lose a pound while on the remeron, even on a very restricted diet. My pdoc, gp and pharmacist didn't belive me. As soon as I stopped the remeron, within a month, I've lost 20lbs. However I can't sleep, I'm fatigued all the time (Trazodone) gives me all day hangover, Wellbutrin's never helped my depression, racing thoughts coming back, negetive thoughts too, anxiety, and irritabitity. I really need to find a good study to give to my pdoc saying that higher dose of remeron is safe, and will not produce the weight gain side effect. I have to go back on remeron, cuz I'm sliding. My pdoc is 70, and done with researching medications etc... So if I go to him and plead my case he will usually give me the medication. I'm also an Rn with 12 years experience in psychiatric nursing, minus 4 off due to this illness. However I can not find anything on the internet. So if anyone can find a research study about using higher dose remeron in patients, I would be so indebted to you. Thank-you for listening.
>
>
>Hi Joanna,
Here is a quote about what you are looking for, it is from http://www.preskorn.com/columns/0003.html and is written by an actual Psychophamocologist.
"Mirtazapine, like imipramine, may have a curvilinear dose-response curve. There is some suggestion that sedation is more pronounced on low rather than high dose mirtazapine therapy (15 versus 30 mg/day or more). This suggestion is principally based on the fact that there was a higher incidence of sedation in the American trials, which used lower doses, than in the European trials, which used higher doses of mirtazapine. There may be other reasons for this finding but that discussion is beyond the scope of this paper. Suffice it to say that the multiple actions of mirtazapine suggest the following theoretical explanation for why this otherwise paradoxical observation might be true. The sedative effect of mirtazapine at low doses is consistent with its high affinity for the histamine-1 receptor. Given that mirtazapine binds more avidly to that site of action than to sites capable of mediating relief from a depressive episode (Figure 1), sedation occurs at doses of mirtazapine below those needed for antidepressant efficacy (i.e., less than 15 mg/day). However, higher doses of mirtazapine result in the blockade of the alpha-2 adrenergic receptor, which produces an alerting or arousal effect just like yohimbine and just the opposite of the sedation produced by the alpha-2 adrenergic agonist, clonidine. Thus, mirtazapine most likely causes sedation at low doses (i.e., concentrations) by preferentially blocking the histamine-1 receptor, while at higher doses (i.e., concentrations), mirtazapine blocks the alpha-2 adrenergic receptor, which theoretically could reduce its sedating effects to some degree. A fixed dose trial or another type of prospective study would be needed to rigorously test this concept."
On that page you can also read why Remeron goes great with SSRI's & Effexor. The whole website is a good read.
If you search through Dr.Bobs you can find lots of user impressions of high & low dose Remeron. My own experience for me is higher doses just make me sleep longer, which is not what you want to hear. OTOH it doesn't make me crave carbs or eat extra. Did you get any kind of response from the SSRI's? Have you tried Effexor? I take Effexor+Remeron & together I think they are great.
Cheers,
Panda.
Posted by Sad Panda on March 26, 2004, at 7:41:06
In reply to Re: Anyone on Remeron dose higher than 60 and above, posted by florence on March 25, 2004, at 12:06:04
> I have taken anywhere from 30 to 45 to 60 to 90 mgs remeron. My doc was right: young people hate it becuz it makes them eat, and senior citizens love it becuz it makes them sleep. I stuck with it since I was too depressed and sleep-deprived to care about weight gain. I was taking Provigil (a stimulant) while on remeron and still gained weight becuz I never had an appetite until the evening when the provigil wore off. SO I eat chocolate every single night. I used to detest sweets! Anyway, I never noticd much difference in 30 or 60 mgs in my mood even though I've been reading that 45 or 60 mgs must be used to improve mood and be energizing. So, I've stopped taking it--taken 30 mgs--and now taking 60 mgs becuz I am tired depressed and desperate. I haven't found any hard core evidence about high doses. But I don't remember 90 helping mor than 60. BUT I am 50 yrs old and my female hormones were flip-flopping all over the place. BUT I can't believe I NEVER heard of water/fluid retention being a problem: SO I attributed this to my female problems. Now I AM positive this "fat" feeling is from remeron. So, I just might risk stopping it and trying something else. I wish it helped my mood more but it doesn't. I am also 5'2" and about 140 lbs now and was 120 lbs up until the time I started 30 mgs remeron.
>
>Hi Florence,
I get bloaty feet with Remeron if I sit for too long & don't do enough walking. My feet act as an excercise meter. :)
Cheers,
Panda.
Posted by Sad Panda on March 26, 2004, at 8:59:29
In reply to Re: Anyone on Remeron dose higher than 60 and above » JoannaC, posted by Sad Panda on March 26, 2004, at 7:14:38
> > Sad Panda
> >
> > I was taking Remeron 15-30 mgs at night for severe unipolar depression. It's the only antidepressant that has ever been effective for me. Unfortunately I gained 45lbs, on top of a 5'2", 110lb frame. I had severe foot, knee and back pain that after a year was intolerable. My pdoc did not give me an option other than going off the remeron. I could not lose a pound while on the remeron, even on a very restricted diet. My pdoc, gp and pharmacist didn't belive me. As soon as I stopped the remeron, within a month, I've lost 20lbs. However I can't sleep, I'm fatigued all the time (Trazodone) gives me all day hangover, Wellbutrin's never helped my depression, racing thoughts coming back, negetive thoughts too, anxiety, and irritabitity. I really need to find a good study to give to my pdoc saying that higher dose of remeron is safe, and will not produce the weight gain side effect. I have to go back on remeron, cuz I'm sliding. My pdoc is 70, and done with researching medications etc... So if I go to him and plead my case he will usually give me the medication. I'm also an Rn with 12 years experience in psychiatric nursing, minus 4 off due to this illness. However I can not find anything on the internet. So if anyone can find a research study about using higher dose remeron in patients, I would be so indebted to you. Thank-you for listening.
> >
> >
> >
>
> Hi Joanna,
>
> Here is a quote about what you are looking for, it is from http://www.preskorn.com/columns/0003.html and is written by an actual Psychophamocologist.
>
> "Mirtazapine, like imipramine, may have a curvilinear dose-response curve. There is some suggestion that sedation is more pronounced on low rather than high dose mirtazapine therapy (15 versus 30 mg/day or more). This suggestion is principally based on the fact that there was a higher incidence of sedation in the American trials, which used lower doses, than in the European trials, which used higher doses of mirtazapine. There may be other reasons for this finding but that discussion is beyond the scope of this paper. Suffice it to say that the multiple actions of mirtazapine suggest the following theoretical explanation for why this otherwise paradoxical observation might be true. The sedative effect of mirtazapine at low doses is consistent with its high affinity for the histamine-1 receptor. Given that mirtazapine binds more avidly to that site of action than to sites capable of mediating relief from a depressive episode (Figure 1), sedation occurs at doses of mirtazapine below those needed for antidepressant efficacy (i.e., less than 15 mg/day). However, higher doses of mirtazapine result in the blockade of the alpha-2 adrenergic receptor, which produces an alerting or arousal effect just like yohimbine and just the opposite of the sedation produced by the alpha-2 adrenergic agonist, clonidine. Thus, mirtazapine most likely causes sedation at low doses (i.e., concentrations) by preferentially blocking the histamine-1 receptor, while at higher doses (i.e., concentrations), mirtazapine blocks the alpha-2 adrenergic receptor, which theoretically could reduce its sedating effects to some degree. A fixed dose trial or another type of prospective study would be needed to rigorously test this concept."
>
> On that page you can also read why Remeron goes great with SSRI's & Effexor. The whole website is a good read.
>
> If you search through Dr.Bobs you can find lots of user impressions of high & low dose Remeron. My own experience for me is higher doses just make me sleep longer, which is not what you want to hear. OTOH it doesn't make me crave carbs or eat extra. Did you get any kind of response from the SSRI's? Have you tried Effexor? I take Effexor+Remeron & together I think they are great.
>
> Cheers,
> Panda.
>
>
>Ooops, that isn't what you were really after, but if it helps H1 blockade is the cause of sedation & allegedly the cause of weight increase.
Cheers,
Panda.
Posted by JoannaC on March 26, 2004, at 14:16:22
In reply to Re: Anyone on Remeron dose higher than 60 and above » florence, posted by Sad Panda on March 26, 2004, at 7:41:06
Thank-you so much for all your information Sad Panda! You Rock!!
Posted by JoannaC on March 26, 2004, at 14:21:58
In reply to Re: Anyone on Remeron dose higher than 60 and above » JoannaC, posted by Sad Panda on March 26, 2004, at 7:14:38
Sorry I was excited about the information you gave me, I didn't respond to your question!! I have tried Effexor. However, I can't take it, I get all the anticolinergic effects, big time...blurred vision, nausea, tremors etc.. It's amazing how different all of our brain chemistries are, and how differently we respond to medications. I'm so happy that you've found something that works for you. Remeron's been my lucky charm, just need to get rid of the weight, and get back on it, cuz I'm sliding fast. Thanks again so much...I've been on a search for information for months now!
Posted by Sad Panda on March 27, 2004, at 12:07:28
In reply to Re: Anyone on Remeron dose higher than 60 and above, posted by JoannaC on March 26, 2004, at 14:21:58
> Sorry I was excited about the information you gave me, I didn't respond to your question!! I have tried Effexor. However, I can't take it, I get all the anticolinergic effects, big time...blurred vision, nausea, tremors etc.. It's amazing how different all of our brain chemistries are, and how differently we respond to medications. I'm so happy that you've found something that works for you. Remeron's been my lucky charm, just need to get rid of the weight, and get back on it, cuz I'm sliding fast. Thanks again so much...I've been on a search for information for months now!
>
>Hi Joanna,
It would pay to watch out for diabetes & also keep an eye on your cholestrol & tryglcerides. If you can't lose weight while taking Remeron, then it must be affecting your metabolism in someway. Another poster on this board takes Remeron only & she is managing to lose weight while taking it. I haven't tried losing weight yet(I need to), but it does give me some foot odema.
Cheers,
Panda.
Posted by Flipsactown on March 27, 2004, at 17:15:10
In reply to Re: Anyone on Remeron dose higher than 60 and abov, posted by rod on March 25, 2004, at 4:01:17
I was on 90mg Remeron for over 6 months for unipolar depression which I have had for over 13 years. At that time I was also on 400mg Lamictal, 900mg Lithium, 100mg Prozac. Currently I tapered off on all AD's and am waiting for a full two weeks after stopping all AD's so I can start taking Nardil, an MAOI drug. After 13 years on so many different AD's, I felt that it was time to try something different. Although Remeron worked to a certain extent for the six months I was on it at 90mg, my depression seemed to return in the late afternoon and progressively gaining more momentum. Also, I gained 40 to 50 lbs. Not good at all!!
FST
> My doctor told me he (and his collegues in hospital) prescibes Remeron up to 90mg. Thats the highest dose which makes sense, according to him.
>
> Roland
This is the end of the thread.
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