![[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 PeterM on October 20, 2002, at 17:48:45
My first post:
After having been on Celexa for almost 2 months, I'm getting a little fed up. 20 mg worked for a couple of weeks then pooped out, 30 mg didn't work and then 40 mg held for about a week (feeling good for the majority of it). Today it pooped out. I was barely able to get out of bed. So, I'm thinking of switching meds. I've used Paxil before - it stopped the anxiety and depression in about 10 days, but the insomnia was awful and getting off of it was worse. My pdoc recommended Remeron when I started the Celexa. It seems Remeron is either a miracle or it doesn't help at all. I've got insomnia, not bad, but certainly haven't had a good restful sleep in quite some time. I know Paxil works, but the side effects are awful. I'm having trouble making up my mind which drug to choose. I also took Serzone 5 years ago, but when a bout of major depression started it didn't help me at all. Anybody have thoughts? Thanks.
Posted by Ritch on October 20, 2002, at 18:30:01
In reply to Remeron vs. Paxil, posted by PeterM on October 20, 2002, at 17:48:45
> My first post:
> After having been on Celexa for almost 2 months, I'm getting a little fed up. 20 mg worked for a couple of weeks then pooped out, 30 mg didn't work and then 40 mg held for about a week (feeling good for the majority of it). Today it pooped out. I was barely able to get out of bed. So, I'm thinking of switching meds. I've used Paxil before - it stopped the anxiety and depression in about 10 days, but the insomnia was awful and getting off of it was worse. My pdoc recommended Remeron when I started the Celexa. It seems Remeron is either a miracle or it doesn't help at all. I've got insomnia, not bad, but certainly haven't had a good restful sleep in quite some time. I know Paxil works, but the side effects are awful. I'm having trouble making up my mind which drug to choose. I also took Serzone 5 years ago, but when a bout of major depression started it didn't help me at all. Anybody have thoughts? Thanks.
I would give the Remeron a try. Revisiting Paxil would likely cause the sfx you had the last time. Remeron you might hate worse, but until you give it a try you won't know. Some folks experience little weight gain and somnolence (after a while) on Rem. If antihistamines taken during the day knock you out badly-it might not be such a great choice. good luck.
Posted by Essence on October 21, 2002, at 6:25:38
In reply to Re: Remeron vs. Paxil » PeterM, posted by Ritch on October 20, 2002, at 18:30:01
I had been on Paxil in the past and found it very affective for depression and anxiety. I had no problems on it with regards to unwanted side affects except for a major loss in vision, which is why I was taken off of it. I am now taking Remeron, which I love, I've had no weight gain, sleep well and wake refreshed, not the case in the beginning though, for the first few weeks I was a walking zombie on it, found it hard to get out of bed. This does pass for some people within a few days, others a few weeks. It was worth it for me,10 wks after starting Rem, I was back to work after having been in a 2 yr depression that left me on the sofa 24/7. I should also mention that at 2 weeks and again at 8 weeks, I had set backs on the Remeron where I thought it was pooping out. The first episode, my psydoc raised it from 15 mg to 30 mg. The second episode, I opted to not have another increase and a cpl of weeks later things settled down again. It's now been 10 1/2 mos and I'm feeling great. The only down side to Rem for me, is that it didn't work for my anxiety. I take Clonazepam, .50 BID for that with about 75% effectiveness. Hope this helps.
Ess
Posted by LyndaK on October 21, 2002, at 12:47:01
In reply to Re: Remeron vs. Paxil, posted by Essence on October 21, 2002, at 6:25:38
Ess,
You are the first I've seen to report NO weight gain on Remeron! I didn't know it was possible! I am a person who has never really had weight issues and I tend to under-eat when depressed rather than over-eat, yet I've gained 20 pounds with this med. and have only lost 3-5 pounds since ramping up to 60mgs per day. Any insights into why you DIDN'T gain weight?
Lynda
Posted by Shawn. T. on October 21, 2002, at 22:31:29
In reply to Re: Remeron vs. Paxil » Essence, posted by LyndaK on October 21, 2002, at 12:47:01
>>Any insights into why you DIDN'T gain weight?
One possible explanation for weight gain from antipsychotics/Remeron is that 5-HT2C antagonism is primarily responsible for the effect.
Lancet 2002 Jun 15;359(9323):2086-7 Related Articles, Links
Association of antipsychotic drug-induced weight gain with a 5-HT2C receptor gene polymorphism.Reynolds GP, Zhang ZJ, Zhang XB.
Department of Biomedical Science, University of Sheffield, Sheffield S10 2TN, UK. g.p.reynolds@sheffield.ac.uk
A side-effect of treatment with antipsychotic drugs for schizophrenia is increased body fat, which leads to further morbidity and poor adherence to treatment. The 5-hydroxytryptamine 2C receptor (5-HT2C) has been associated with this effect; we aimed to establish whether a genetic polymorphism of the promoter region of this receptor affects weight gain after drug treatment in first-episode patients with schizophrenia. We noted significantly less weight gain in patients with the -759T variant allele (p=0.0003) than in those without this allele, who were more likely to have substantial (>7%) weight gain (p=0.002). We have identified a genetic factor that is associated with antipsychotic drug-induced weight gain.
Shawn
Posted by PeterM on October 21, 2002, at 23:10:32
In reply to Re: Remeron vs. Paxil, posted by Essence on October 21, 2002, at 6:25:38
Posted by LyndaK on October 22, 2002, at 0:05:38
In reply to Re: Remeron vs. Paxil » LyndaK, posted by Shawn. T. on October 21, 2002, at 22:31:29
Hi Shawn,
Thanks for your response. I didn't know that Remeron was considered an antipsychotic. I don't have schizophrenia and I'm not psychotic. It was prescribed to treat my depression.
In all honesty, I'm not a scientist/chemist type of person, so the link was a little lost on me. Sorry.
Lynda
Posted by Shawn. T. on October 22, 2002, at 16:38:48
In reply to Re: Remeron vs. Paxil » Shawn. T., posted by LyndaK on October 22, 2002, at 0:05:38
You're welcome... all you really needed to gather from the link is that 5-HT2C antagonists can affect certain people with a genetic alteration differently than others. Remeron isn't really considered an antipsychotic. It affects 5-HT2A and 5-HT2C receptors like many antipsychotics, but for a different reason altogether. Blocking those receptors reduces some of the side effects that result from increased extracellular serotonin levels in the brain. However, Remeron/mirtazapine has been shown to be an effective add-on treatment for haloperidol for people with schizophrenia. Note that haloperidol is a dopamine D2 receptor antagonist and also that the following link doesn't mention that Remeron is a 5-HT2C antagonist.
Shawn
Posted by LyndaK on October 22, 2002, at 22:42:21
In reply to Re: Remeron vs. Paxil » LyndaK, posted by Shawn. T. on October 22, 2002, at 16:38:48
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.