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Re: Why do people not like Amitriptyline + Mirtazapine Christ_empowered

Posted by mtom on June 10, 2019, at 11:54:52

In reply to Re: Why do people not like Amitriptyline + Mirtazapine, posted by Christ_empowered on June 10, 2019, at 8:23:10

My doc is thinking of adding low dose Remeron to my currently low dose escitalopram (lexapro).

I thought of Amitriptyline because a recent Lancet review found it most effective of 21 AD's, although 6th for acceptability.

She avoided Wellbutrin with me because some people report over-stimulation, and this is a problem for me for other AD's. In addition, a Genetic Report I did last year indicated one of my P450 enzyme alleles correlates to an increased response to Bupropion (Welbutrin).

With my anxiety, I need to avoid anything stimulating (I even drink decaf coffee & tea now).

Some people report increased anxiety with Remeron. Also there is the problem with somnolence (and possibly too much weight gain). I don't see that many reports of efficacy for depression, although that study rated it #2 for this (but actual data they based this on seems limited).

None of the other TCA's you mentioned were included in the 21 meds reviewed in the large Lancet study I've referred to in other posts.(?). The only other TCA in that study was clomipramine, and it was at the bottom for acceptability (i.e. the worst).


> hi. in the US, remeron is often used with other Rx drugs. wellbutrin+remeron, an ssri+remeron, effexor+remeron (that's "california rocket fuel," apparently...), etc. in the US, the tendency is to use somewhat lower doses than are (were?) popular in the EU, for whatever reason(s).
>
> If you and your doctor(s) opt for a tca, are you sure you want to settle on Elavil? Tofranil, vivactil, even...surmontil...there are plenty of tca drugs still on the market, and I think the adverse effect profile of some of them might be better in your situation than good ole elavil. but i could be wrong, obviously.
>
> one treatment I saw...was using a sustained release stimulant in combination with remeron. never known anyone on that combination, but the idea was to enhance the ad action (and help sedation and fatigue) with a stimulant and then improve sleep and anxiety with the remeron. wellbutrin+remeron might be somewhat similar (?).
>
> have you been prescribed modafanil or anything to help w/ fatigue? i dont think its addictive or anything, its just...an option some people seem to benefit from, so i thought id mention it.
>
> hope things get better for you.


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poster:mtom thread:1104810
URL: http://www.dr-bob.org/babble/20190513/msgs/1104814.html