Posted by MoBe on September 4, 2002, at 22:15:17
In reply to Re: remeron/wellbutrin » MoBe, posted by SLS on September 3, 2002, at 11:19:56
> Hi MoBe.
>
> > Regarding Remeron and Wellbutrin combination- for the last couple of months I have been on 15 mg Remeron and 150 mg wellbutrin. This does wonders for my insomnia and my ADD but doesn't quite lift the depression well enough. I don't seem to have any side effects on this dose - but when I increase either (in order to lift the depression) I end up getting myoclonus (the muscle jerking). I'm wondering if this is part of serotonin syndrome ie. is it dangerous. It usually subsides in about an hour but it's fairly bothersome for that hour.Has anyone had their psychdoc comment on those symptoms???
>
> Generally, I don't think one would think of serotonin syndrome as a consequence of combining these two drugs. However, there are almost always idiosyncratic events or paradoxical reactions associated with almost any psychotropic drug. Wellbutrin is not well understood, and I have seen abstracts on Medline that postulate that it will increase serotonin (5-HT) activity via its action on norepinephrine (NE).
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11374336&dopt=Abstract
>
>
>
> Here is a case in which Remeron monotherapy was clearly responsible for the induction of serotonin syndrome:
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11918514&dopt=Abstract
>
>
> Taken together, both of these abstracts yield in my mind the possibility that serotonin syndrome might be a rare adverse interaction between Wellbutrin and Remeron.
>
> For depression, it is usually not advisable to evaluate the effectiveness of Wellbutrin until reaching 300mg. Perhaps it is worth discontinuing Remeron in favor of another strategy to treat insomnia. There are many.
>
>
>
> The symptoms of serotonin syndrome include the following:
>
> Mental status changes
> Confusion (51%)
> Agitation (34%)
> Hypomania (21%)
> Anxiety (15%)
> Coma (29%)
>
> Cardiovascular
> Sinus tachycardia (36%)
> Hypertension (35%)
> Hypotension (15%)
>
> Gastrointestinal
> Nausea (23%)
> Diarrhea (8%)
> Abdominal pain (4%)
> Salivation (2%)
>
> Motor Abnormalities
> Myoclonus (58%)
> Hyperreflexia (52%)
> Muscle rigidity (51%)
> Restlessness (48%)
> Tremor (43%)
> Ataxia/incoordination (40%)
> Shivering (26%)
> Nystagmus (15%)
> Seizures (12%)
>
> Other
> Diaphoresis (45%)
> Unreactive pupils (20%)
> Tachypnea (26%)
> Hyperpyrexia
>
>
>
> I hope this helps.
>
>
> - ScottDear Scott
Thanks very much for your help. I have actually tried wellbutrin SR 150mg BID. It helped with my ADD but not as much for the depression. When I began 15 mg Remeron the Doctor decreased the wellburin to 150mg. OD. I feel "more up" when I keep the wellbutrin at 150mg and up the remeron to 30 or 45 mg. a day - but then, of course comes the myoclonus. Since this is the only symptom of serotonin syndrome I'm getting I actually tried to treat the symptom with valerian and it worked. However, I have no idea how risky it is to take these three together for an extended period. Thanks for any input.
MoBe
poster:MoBe
thread:33306
URL: http://www.dr-bob.org/babble/20020829/msgs/118829.html