Posted by Toby on December 31, 1998, at 8:56:18
In reply to Re: Appetite, posted by DL on December 30, 1998, at 12:22:21
One can never predict or reason out why one medication does badly and another one does well even when they are supposed to do similar things. For example, some kids respond to ritalin for ADD and some respond to dexedrine, but swap one for the other and they may do just dreadfully. Theorectically, both are just stimulants and should have the same effects and same side effects, but it just doesn't work that way. In the Bible it says,"we are wonderfully made," which I have seen to be modernly translated as "mysteriously." In this business I see it is true.
I have seen that it is true also about the caffeine phenomenon you mentioned. It can be a good predictor, though not always absolutely. I mostly use it for a predictor of who to start their SSRI dose (if there is a compelling reason to use one over another kind of antidepressant) at a very tiny tiny dose rather than the standard starting dose.
I have generally not seen a change in sleep when increasing the dose of Remeron, especially in a patient who has been on it as long as you have. The reason may be that the sleep has finally responded in conjunction with the relief from depression (since insomnia is a symptom of depression), instead of being a separate entity that needed treatment. Raising the dose then, would be mainly for reducing side effects; but, too, if you are thinking you need more anitdepressant effect since you mentioned adding an SSRI, perhaps the dose needs to be raised to get more antidepressant effect from the Remeron itself.
Have a Happy New Year. Will talk at you again on Monday on a new post since these will be gone.
poster:Toby
thread:1428
URL: http://www.dr-bob.org/babble/19981201/msgs/1929.html