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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by tensor on December 5, 2009, at 7:49:31
Trying to get off Remeron. Took my last dose five days ago. I have replaced it with Edronax, but my depression is getting deeper and deeper, and I have terrible insomnia. Is this due to discontinuation symptoms or due to the possibility that I need Remeron to feel better?
/tensor
Posted by SLS on December 5, 2009, at 8:08:12
In reply to Discontinuation symptoms or not?, posted by tensor on December 5, 2009, at 7:49:31
> Trying to get off Remeron. Took my last dose five days ago. I have replaced it with Edronax, but my depression is getting deeper and deeper, and I have terrible insomnia. Is this due to discontinuation symptoms or due to the possibility that I need Remeron to feel better?
It is hard to tell at this early juncture. You made two changes at the same time. If the depression gets worse instead of better, then it is likely that something other than a withdrawal depressive rebound is going on.
It may be that if you were to try taking a small amount of Remeron and observe that your depression gets better, your depression is a withdrawal phenomenon. I don't know if I would actually recommend such an action, though.
It could even be an untoward reaction to the Edronax. I reacted to Edronax by having my depression made much worse. Insomnia is a possible side effect of this drug.
- Scott
Posted by tensor on December 5, 2009, at 8:48:30
In reply to Re: Discontinuation symptoms or not? » tensor, posted by SLS on December 5, 2009, at 8:08:12
> It is hard to tell at this early juncture. You made two changes at the same time. If the depression gets worse instead of better, then it is likely that something other than a withdrawal depressive rebound is going on.
>
> It may be that if you were to try taking a small amount of Remeron and observe that your depression gets better, your depression is a withdrawal phenomenon. I don't know if I would actually recommend such an action, though.
>
> It could even be an untoward reaction to the Edronax. I reacted to Edronax by having my depression made much worse. Insomnia is a possible side effect of this drug.
>
>
> - ScottI guess I have to wait a little longer and see what happens. I have kept my Edronax dosage at 6mg/day and my Zoloft dosage at 100mg.
Have you had any luck with dopamine agonists like pramipexole?/tensor
Posted by SLS on December 5, 2009, at 9:32:23
In reply to Re: Discontinuation symptoms or not? » SLS, posted by tensor on December 5, 2009, at 8:48:30
> I guess I have to wait a little longer and see what happens.
> I have kept my Edronax dosage at 6mg/day and my Zoloft dosage at 100mg.
If you are looking for a noradrenergic drug to combine with Zoloft or other SRIs, don't forget about nortriptyline. Unfortunately, it seems that desipramine has been linked to untoward cardiac events in vulnerable individuals. I have never had a problem with it. If one is to use desipramine, it is a good idea to get a baseline EKG to look for conduction anomalies prior to starting the drug. One would then want to have follow up EKGs subsequent to initializing therapy.
> Have you had any luck with dopamine agonists like pramipexole?
That's a good thought. Thanks. Perhaps the Abilify I'm taking would prevent the sleep attacks that pramipexole can induce.
It has been at least 10 years since I tried bromocriptine (Parlodel). It produced a mild improvement for a few days. Pramipexole would be worth a try for me since it stimulates D3 receptors along with the D2 receptors that bromocriptine is limited to.
- Scott
Posted by tensor on December 5, 2009, at 10:02:38
In reply to Re: Discontinuation symptoms or not? » tensor, posted by SLS on December 5, 2009, at 9:32:23
> If you are looking for a noradrenergic drug to combine with Zoloft or other SRIs, don't forget about nortriptyline. Unfortunately, it seems that desipramine has been linked to untoward cardiac events in vulnerable individuals. I have never had a problem with it. If one is to use desipramine, it is a good idea to get a baseline EKG to look for conduction anomalies prior to starting the drug. One would then want to have follow up EKGs subsequent to initializing therapy.
>
> It has been at least 10 years since I tried bromocriptine (Parlodel). It produced a mild improvement for a few days. Pramipexole would be worth a try for me since it stimulates D3 receptors along with the D2 receptors that bromocriptine is limited to.
>
>
> - ScottI had a good run with nortrityline several years ago, it worked great for a year or so. Actually, I have been thinking of switching from Edronax to nortrip if my current regime fails. Desipramine is not available here, but could be imported with relative ease, just need a licence from my pdoc.
How is Abilify working for you? I have been thinking if I could benefit from it but there are a couple of things I want to try first. Pramipexole looks interesting,
http://www.biopsychiatry.com/pramipexoledep.htm/tensor
Posted by Katgirl on December 5, 2009, at 10:19:03
In reply to Re: Discontinuation symptoms or not? » SLS, posted by tensor on December 5, 2009, at 10:02:38
When I went through withdrawal to Remeron, the symptoms did not start until around day 8 or so, I believe. I had pronounced GI symptoms, dizziness and vertigo. And of course, it took a long long time to learn to sleep again without it. But i don't think that was a sign of withdrawal, it was just my body trying to learn how to sleep without a "sleeping" drug! Good luck!! (I think most people don't experience withdrawal to remeron, I was just one of the lucky ones!)
Posted by Phillipa on December 5, 2009, at 10:53:54
In reply to Re: Discontinuation symptoms or not?, posted by Katgirl on December 5, 2009, at 10:19:03
It reminds me of this tiny 50mg dose of luvox been on for at least ll years but something will not allow my brain to give it up? Now remeron neither made me tired or gain weight took for over 30 days then just stopped it. How come for some they get GI side effects I've never had any? Phillipa sorry for off topic
Posted by bleauberry on December 5, 2009, at 15:03:16
In reply to Discontinuation symptoms or not?, posted by tensor on December 5, 2009, at 7:49:31
At this early stage, having made two changes at a time, it is difficult to know what is doing what.
I think the size of the final dose and the length of time of the weaning process would give some clues. For example, if the weaning process was fast (2 to 4 weeks), risk is high that remeron is a factor. If the last dose was in the 7.5mg to 15mg range, the risk is very high. Smoother remeron weanings involve time (2-3 months) and very tiny steps down, working down to a final dose of around 1 to 2mg...mere specks sliced off the sides of the pills.
On the other hand, too much norepinephrine can make some people very very depressed. It's a deep dark depression that didn't exist prior to the med, and starts in the 1 to 4 day timeframe.
I think it would be wise to cut the Rebox dose in half...I know it's already lowish, but make it lower...3mg...or even 1.5mg...and add back a smidgen of remeron...3mg to 7.5mg. Try to get back a little closer to where you were, and then stay on track with the new meds except with a slower wean off Remeron coming down in tiny steps, and a slower climb into Rebox.
Better yet, as has already been mentioned, Nortriptyline, or even better Amitriptyline.
Posted by tensor on December 5, 2009, at 19:55:23
In reply to Re: Discontinuation symptoms or not?, posted by bleauberry on December 5, 2009, at 15:03:16
> At this early stage, having made two changes at a time, it is difficult to know what is doing what.
>
> I think the size of the final dose and the length of time of the weaning process would give some clues. For example, if the weaning process was fast (2 to 4 weeks), risk is high that remeron is a factor. If the last dose was in the 7.5mg to 15mg range, the risk is very high. Smoother remeron weanings involve time (2-3 months) and very tiny steps down, working down to a final dose of around 1 to 2mg...mere specks sliced off the sides of the pills.
>
> On the other hand, too much norepinephrine can make some people very very depressed. It's a deep dark depression that didn't exist prior to the med, and starts in the 1 to 4 day timeframe.
>
> I think it would be wise to cut the Rebox dose in half...I know it's already lowish, but make it lower...3mg...or even 1.5mg...and add back a smidgen of remeron...3mg to 7.5mg. Try to get back a little closer to where you were, and then stay on track with the new meds except with a slower wean off Remeron coming down in tiny steps, and a slower climb into Rebox.
>
> Better yet, as has already been mentioned, Nortriptyline, or even better Amitriptyline.I came off Remeron fast, five days at 15mg then four days at 7.5mg. I agree it's difficult to say when several changes are done at the same time. I'm gonna cut back on Edronax to 2x2mg, but will continue to try without any Remeron. Nortrip is definitely a good choice, I don't know how safe it is to combine with an SSRI though.
/tensor
Posted by floatingbridge on December 9, 2009, at 0:10:15
In reply to Re: Discontinuation symptoms or not? » bleauberry, posted by tensor on December 5, 2009, at 19:55:23
> I'm gonna cut back on Edronax to 2x2mg, but will continue to try without any Remeron. Nortrip is definitely a good choice, I don't know how safe it is to combine with an SSRI though.
>
> /tensorI was wondering if cutting back on the Edronax might help alleviate some of the depression. How are you today?
fb
Posted by tensor on December 9, 2009, at 3:49:40
In reply to Re: Discontinuation symptoms or not? » tensor, posted by floatingbridge on December 9, 2009, at 0:10:15
> I was wondering if cutting back on the Edronax might help alleviate some of the depression. How are you today?
>
>
> fb
>I quit Edronax a few days ago, it just gives me rapid heartbeat. I'm having some discontinuation symptoms from Remeron, chills and anxiety etc. Seeing my pdoc today, we'll what we decide.
/tensor
Posted by Phillipa on December 9, 2009, at 18:48:28
In reply to Re: Discontinuation symptoms or not? » floatingbridge, posted by tensor on December 9, 2009, at 3:49:40
Tensor how did it go? Phillipa
Posted by tensor on December 10, 2009, at 1:34:31
In reply to Re: Discontinuation symptoms or not? » tensor, posted by Phillipa on December 9, 2009, at 18:48:28
> Tensor how did it go? Phillipa
Hi!
I'm keeping 100mg Zoloft and we added Lyrica 75mgx2. If Lyrica is successful, I will start weaning myself off clonazepam after christmas.
/tensor
Posted by Phillipa on December 10, 2009, at 19:03:19
In reply to Re: Discontinuation symptoms or not? » Phillipa, posted by tensor on December 10, 2009, at 1:34:31
Tensor do you have to be off the benzo before the lyrica? I've heard it's good. Phillipa
Posted by tensor on December 10, 2009, at 21:13:51
In reply to Re: Discontinuation symptoms or not? » tensor, posted by Phillipa on December 10, 2009, at 19:03:19
> Tensor do you have to be off the benzo before the lyrica? I've heard it's good. Phillipa
No, already started Lyrica and I can already feel its anxiolytic effects. The thought is to start taper clonazepam after christmas if Lyrica is strong enough.
/tensor
Posted by Phillipa on December 10, 2009, at 21:34:55
In reply to Re: Discontinuation symptoms or not? » Phillipa, posted by tensor on December 10, 2009, at 21:13:51
What dose are you on? Let me know if weight gain it's a side effect. Phillipa
Posted by tensor on December 11, 2009, at 0:01:15
In reply to Re: Discontinuation symptoms or not? » tensor, posted by Phillipa on December 10, 2009, at 21:34:55
> What dose are you on? Let me know if weight gain it's a side effect. Phillipa
150mg/day, will probably increase soon or at least a few days before clon taper.
I don't follow my weight really, but I cancelled Remeron, perhaps it will cancel each other out./tensor
Posted by Phillipa on December 11, 2009, at 19:49:48
In reply to Re: Discontinuation symptoms or not? » Phillipa, posted by tensor on December 11, 2009, at 0:01:15
Tensor sounds good. Phillipa
Posted by floatingbridge on December 12, 2009, at 4:58:15
In reply to Re: Discontinuation symptoms or not? » Phillipa, posted by tensor on December 10, 2009, at 21:13:51
> > Tensor do you have to be off the benzo before the lyrica? I've heard it's good. Phillipa
>
> No, already started Lyrica and I can already feel its anxiolytic effects. The thought is to start taper clonazepam after christmas if Lyrica is strong enough.
>
> /tensorWow. Let us know how you do.
best, fb
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