![[dr. bob]](/dr-bob-sm.gif)
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 viper1431 on February 5, 2010, at 21:44:15
I've had a problem for a long time with my body feeling tired/weak and just generally not wanting to do anything at all, it's been hard to describe to the doctor and i've had just about every blood test we can think of and tried a hell of a lot of meds. Anyway a couple times in the last week i've tried some mirtazapine to get some sleep, only half a tab so aprox 7.5mg.. i took it last night and 14 hours later i'm still feeling terrible.. thing is it's feeling like the horrid feeling i normally complain about only stronger.. it's more my body feeling weak and tired than my head which actually feels clear and wants to get out and about but my body isn't letting me. Is there some clue as to what may normally be wrong with me by the fact that some sort of effect from mirtazapine is applifying it by 10times ? Just finished typing this message and my arms feel like i've just ben lifting 20pond dumbbells the whole time.
Posted by X-ray on February 6, 2010, at 2:47:33
In reply to mirtazapine side effects.. clue?, posted by viper1431 on February 5, 2010, at 21:44:15
Hi,
The bad side effects of mirtazapine are weight gain and sedation.
Now I'm on a mirtazapine/Wellbutrin combo.
I'm not tired anymore.Best regards,
X-ray
Posted by conundrum on February 6, 2010, at 7:08:02
In reply to mirtazapine side effects.. clue?, posted by viper1431 on February 5, 2010, at 21:44:15
If you are trying mirtazapine solely for sleep benefit and not depression/anxiety then you might wanna try another drug, its one of the strongest antihistamines on earth and probably is doing more harm than good. If you are taking it for an antidepressant response, your dose is too low. THe higher the dose the more activating it should become. Emphasis on SHOULD.
Posted by bleauberry on February 6, 2010, at 9:10:37
In reply to mirtazapine side effects.. clue?, posted by viper1431 on February 5, 2010, at 21:44:15
You might want to do some google researching on "Chronic Fatigue Syndrome". It's hard to say on such a short description over the internet, and it is usually done on clinical evidence. Maybe your doctor doesn't know much about it and doesn't realize you might have it? As with depression itself, CFS is kind of a subjective diagnosis, at the mercy of the perception of whoever is looking at it. There is no lab test to say "you have depression" or "you have CFS".
Key word..."might". It fits the description.
But this gets into murky waters. Fatigue in the extremities, and the body overall, is one of the symptoms of depression. But are the fatigue and depression themselves symptoms and not diseases, symptoms of yet something else? Could be. In no way am I saying you have a bacterial infection, Lyme, or Candida, but they do look exactly the same as what you describe. So you see what I mean about things getting murky. It's hard to know what's causing what, what came first, whether to treat a disease on a hunch based on clinical presentation, or whether to just confine your treatments to alleviating symptoms as best as possible.
That said, remeron is probably not a good choice for someone whos baseline is fatigue. If it were to be used at all, it would probably need to be at least 30mg-45mg (where stimulation is more prominent than sedation), or in combination with something stimulating.
Low dose Savella.
Ritalin (brand, not generic).
Prozac+Ritalin (both brand, not generic).
Wellbutrin brand (not generic).
Low dose Abilify (1mg-5mg).
Parnate.
Nortriptyline.Those are things that could be on your radar screen. Some could be monotherapy and some could be combined.
If you need sedation assistance and remeron is your choice, 7.5mg is much more than you need. Believe me. Try cutting that 7.5mg in half or even quarters. I found that even doses as small as about 3mg were even more sedating than 7.5mg, but didn't have as much of the strong hangover into the next day. Even 1mg, mere crumbs, can pack a punch at bedtime.
Other options for sleep:
Low dose Nortriptyline (5mg-10mg)
LunestaSeroquel or Trazodone are both popular choices for sleep, but I personally do not favor those approaches. They are however good candidates in the sleep department.
Chronic Fatigue Syndrome is usually treated with stimulating antidepressants and stimulants. To get to the root cause of it, most success stories involved the use of antibiotics and/or antifungals, indicating an unsuspected undiagnosable infectious pathogenic cause. Those success stories abound all over the worldwide web, forums, and youtube, but most could not be reliably diagnosed by labs, and were instead attacked on the preponderance of evidence...basically blind trials that ended up being bullseye correct. CFS can be helped by antidepressants and stimulants, but the cures are usually antibiotics. Much research is needed, so we have to go on anecdotal evidence, which points the way to infectious diseases. Most of those will not show up relaibly in blood tests, which is why people who get chronic fatigue still have it decades later...doctor's view lab tests are perfect, but they are far from it.
On a 1-10 scale, food choices alone can make a difference of 2 or 3 points on the scale in terms of the fatigue you feel. It basically entails an entirely new approach to eating...eat for health, not for pleasure. That too is a another story, but basically we're talking heavy on veggies and fruits, lean meats, the good fats (olive oil, avocado, nuts of all kinds, fish), very low sugars, frequent small meals, and avoiding most things that are white (white bread, white grains), and doing self-tests to see how you feel after not eating gluten for 2 weeks, and another to see how you feel not consuming any cow dairy for 2 weeks. These kinds of things can improve your energy scores all by themselves without any meds. Probably sleep better too.
Posted by viper1431 on February 6, 2010, at 10:11:44
In reply to Re: mirtazapine side effects.. clue?, posted by bleauberry on February 6, 2010, at 9:10:37
I havn't tried the stimulants due to them being so restricted in australia however ones on there you did mention i have tried all made me worse, they actually made me more tired and weak and inthe case of parnate puts me right out to sleep, i have tried the wellbutrin but only in SR version as it's all we have, prozac made me want to go on a rampage, nortriptyline made me tired and weak and bad tempered and reboxetine feels like a sedative. So that's why i kept the mirtazapine at the low dose as my body doesn't seem to like noradrenaline but i wanted to be knocked out for a while to really get some sleep. I used to use 25mg of seroquel for 7 hours sleep but i still feel wierd when i wake up so i was hoping the mirtazapine wouldn't do the same.
Was wondering if it's possible to be ultra sensative to anti-histamines or even have a low amount to begin with and that can cause trouble ?
On an interesting note, thanks to the way my body is so silly, benzos make me feel more awake rather than sedating or helping with sleep, so i take 3mg alprazolam a day to help keep me up and about.
Posted by Phillipa on February 6, 2010, at 13:56:24
In reply to Re: mirtazapine side effects.. clue? » bleauberry, posted by viper1431 on February 6, 2010, at 10:11:44
Viper benzos relieved anxieity so felt good and energy like you say got almosst 40 years from them now tired again but got some resiratory thing. Now. Could you be sick? Love Phillipa
Posted by Alexanderfromdenmark on February 7, 2010, at 13:23:38
In reply to mirtazapine side effects.. clue?, posted by viper1431 on February 5, 2010, at 21:44:15
You should take at least 15 mg mirtazapine. 7.5 mg will do excatly what it's doing know. If you are not going higher, I'm not sure mirtazapine is a good solution for your sleeping problems.
Posted by bleauberry on February 7, 2010, at 14:41:08
In reply to Re: mirtazapine side effects.. clue? » bleauberry, posted by viper1431 on February 6, 2010, at 10:11:44
Well, I'm so sorry you've had so much trouble. You've obviously put a valiant effort into trying some worthwhile things.
It does look confusing. I can't quite put my finger on it. My general impression is there is something else going on...thyroid, sub-clinical insulin resistance, cortisol imbalance. Something's going on. Whatever it is, it probably won't be easy to pinpoint.
To conclude that your body doesn't like norepinephrine I think might be an oversimplified generalization. It's a lot more complicated than that.
Children with ADD calm down and relax when given stimulants. A clue? I think so.
Reboxetine makes a lot of people tired. Not a clue.
Prozac has rage as a common side effect. Not a clue.
Parnate is usually stimulatory, but put you to sleep. A clue? I think so.
Nortriptyline...well, it did the same to me as to you, so I'm not sure that's a clue or not...it's doing so many other things it's hard to say.
When you've experimented with Remeron doses between 1mg and 30mg, you'll have more clues. Hopefully at a 30mg dose you'll have a surprising benefit, if you can weather the obvious expected sedation for a week or two. No matter, win or lose, you'll get some clues.
Xanax...a definite clue. In a pubmed study, one group of researchers used 3mg xanax to treat depression and had a high response rate...small study, probably not well structured, but still worth considering...their theory was that GABA is involved in various disorders. Xanax also has some indirect poorly studied impact on enhancing both serotonin and dopamine function. One negative is that when it wears off, it causes a cortisol spike from rebound. That pattern itself can cause a viscious cycle of problems similar to what you describe.
What all these clues mean, well, that's another story. I guess we could armchair quarterback that all day. But they do mean something. All those medication failures were not losses. There are pieces of the puzzle there to try to figure out.
In the meantime, the most significant clues I see are the positive paradoxical response to Xanax and the negative paradoxical response to stimulants and Parnate. I wish I could tell you what all that means. From my brief explorations into ADD, it probably has something to do with dopamine receptors.
As I see the whole conglomerate of things in your case, two things that would make sense to try, in my mind, would be...
1. Low dose (1mg-5mg) abilify.
2. Benadryl (to test the histamine sensitivity you mentioned)
3. I can't really back this up with anything more than a hunch, but I would also put a mention in for Milnacipran. Strong on NE, but forget that...it's a lot different than the other NE drugs you've taken.> I havn't tried the stimulants due to them being so restricted in australia however ones on there you did mention i have tried all made me worse, they actually made me more tired and weak and inthe case of parnate puts me right out to sleep, i have tried the wellbutrin but only in SR version as it's all we have, prozac made me want to go on a rampage, nortriptyline made me tired and weak and bad tempered and reboxetine feels like a sedative. So that's why i kept the mirtazapine at the low dose as my body doesn't seem to like noradrenaline but i wanted to be knocked out for a while to really get some sleep. I used to use 25mg of seroquel for 7 hours sleep but i still feel wierd when i wake up so i was hoping the mirtazapine wouldn't do the same.
>
> Was wondering if it's possible to be ultra sensative to anti-histamines or even have a low amount to begin with and that can cause trouble ?
>
> On an interesting note, thanks to the way my body is so silly, benzos make me feel more awake rather than sedating or helping with sleep, so i take 3mg alprazolam a day to help keep me up and about.
Posted by manic666 on February 12, 2010, at 6:13:08
In reply to mirtazapine side effects.. clue?, posted by viper1431 on February 5, 2010, at 21:44:15
have you ever heard the saying .///im to tierd to sleep, //sounds crazy but you can be .// you body is so tired all day it kinda stays that way 24.7 with no real sleep//.could well be depression. could well be you need a holiday or a good rest with a pick me up , hey how about a couple of red bull energy drinks ,no kidding you never know.///one things for certain keep takeing mirtazapine an you will wake a little fater every day,// you only have to show me the box an i put on weight,./// did you know they give mirtazapine to anorexic,s i wonder why???????????
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.