Posted by Lupercal on July 4, 2001, at 2:12:07
In reply to Re: Remeron - less sedation at higher dose? » Lupercal, posted by Elizabeth on July 3, 2001, at 16:22:44
Hi, Elizabeth
> > I have tried 8 AD's thus far without success. SSRI's work great on my depression, but had to discontinue them all because of horrible (non-reversible) tinnitus side effect * I am about to start on Mirtazapine (Remeron).
>
> Good choice. It's a novel AD, and I've known several people who had no luck with several classes of ADs and then had great success with Remeron.I hope so. I should stress that I had _great_ success with the AD qualities of SSRI's - just that the screaming tinnitus was unbearable. Luvox in particular had a magic bullet effect, improving my mood substantially within 8 hours! Unfortunately it was also the worst of the lot for tinnitus intensity, which unfortunately suggests not only that my serotonin system is extremely sensitive, but that my tinnitus is somehow tied up with it. I'm hoping it's more to do with the means the SSRI's achieve serotonin increase, rather than the increase per se, because mirtazepine has a serotinin effect, too.
> > Previously I have tried Mianserin, which I understand is a very close analog of Remeron.
>
> Mirtazapine is a metabolite of mianserin. They're both pretty strong antihistamines, which is probably why they're so sedating.
>
> > a lot of what I'm reading is that, in theory anyway, the sedation (and possibly weight gain) side effects are inclined to disappear at doses above 30mg per day.
>
> Yes. I started Remeron at 30 mg and had no problems with sedation at all. My pdoc says his experience is that people generally tolerate it better if they start out at a higher dose, so he usually starts people out at 30 mg.I read that one of the doc's who authored one of the orignal studies strongly recommended starting people at 30, but all the other literature suggests slow increase. However, if starting at 30 would avoid the sedation - and if it's _nescessary_ to start at 30 to avoid the sedation, I would be willing to try. My main reason for wanting to start at a lower dose is ion case there is a tinnitus (or other unwelcome) side effect.
I stuck out mianserin for 2 weeks, with no sign of habituating to the sedation effect, and a deterioration in mood. I sure hope this one works diferently, because it's getting close to a last resort. The TCA's are capable of causing tinnitus/hearing loss, and I actually suffered 15db of hearing loss after being on pamelor, which may or may not be coinicidence, but no-one has given me another explanation for it.
I'm rambling, sorry.
NB, Remeron is such a new drug in Australia that none of the GP's or phamacist's have any information about it on their computers, so they're all saying "You know more about it than I do" - which doesn't help much when it comes to making an informed decision about dosage. So thanks for your help.
Tim
poster:Lupercal
thread:68802
URL: http://www.dr-bob.org/babble/20010701/msgs/68912.html