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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by McPac on May 1, 2003, at 18:47:04
These are characteristics of Remeron:
NE-alpha2 antagonist
5-HT2a antagonist
5-HT2c antagonist
5-HT3 antagonist
H1 antagonistZoloft:
5-HT reuptake inhibitorNow the question....if someone were to take Remeron AND Zoloft together.......if Remeron is an ANTAGONIST of different 5-HT receptors and Zoloft is a 5-HT inhibitor, would the two meds be CANCELLING each other out at these sites (thereby producing little good effects)? THANKS!
Posted by ace on May 2, 2003, at 1:05:24
In reply to Can Anybody help answer this question?, posted by McPac on May 1, 2003, at 18:47:04
Posted by Caleb462 on May 2, 2003, at 2:31:49
In reply to Can Anybody help answer this question?, posted by McPac on May 1, 2003, at 18:47:04
> These are characteristics of Remeron:
> NE-alpha2 antagonist
> 5-HT2a antagonist
> 5-HT2c antagonist
> 5-HT3 antagonist
> H1 antagonist
>
> Zoloft:
> 5-HT reuptake inhibitor
>
> Now the question....if someone were to take Remeron AND Zoloft together.......if Remeron is an ANTAGONIST of different 5-HT receptors and Zoloft is a 5-HT inhibitor, would the two meds be CANCELLING each other out at these sites (thereby producing little good effects)? THANKS!
Well... Antagonism of 5-HT2 receptors could be a good thing when combined with Zoloft - no ihibition of dopamine. Aren't the 5-HT1 receptors considered the most important in terms of anti-depressant response? I'm not sure... I'll do some searching and get back to you if I find anything good.
Posted by Caleb462 on May 2, 2003, at 2:48:22
In reply to Can Anybody help answer this question?, posted by McPac on May 1, 2003, at 18:47:04
"In major depression, an increase in 5-HT1A transmission is thought to be a crucial determinant of the antidepressant response"
http://collection.nlc-bnc.ca/100/201/300/cdn_medical_association/jpn/vol-26/issue-1/0037.htm
However... I also found several sources that mentioned 5-HT2 downregulation as being important in anti-depressant response, continued use of a 5-HT2 antagonist would likely result in 5-HT2 upregulation - though I guess initially 5-HT2 antagonism would mimic 5-HT2 downregulation. I dunno.... depression and anti-depressants just aren't well understood - lots of contradictions and confusion. Remeron works by itself though, and I would think combining it with Zoloft would only help it's action as anti-depressant.
Posted by cybercafe on May 2, 2003, at 2:50:31
In reply to Can Anybody help answer this question?, posted by McPac on May 1, 2003, at 18:47:04
> These are characteristics of Remeron:
> NE-alpha2 antagonist
> 5-HT2a antagonist
> 5-HT2c antagonist
> 5-HT3 antagonist
> H1 antagonist
>
> Zoloft:
> 5-HT reuptake inhibitor
>
> Now the question....if someone were to take Remeron AND Zoloft together.......if Remeron is an ANTAGONIST of different 5-HT receptors and Zoloft is a 5-HT inhibitor, would the two meds be CANCELLING each other out at these sites (thereby producing little good effects)? THANKS!
the serotonin unable to bind with 5ht2a, 5ht2c, 5ht3 would just bind with other receptors .. so of course it will exert an effectdon't forget that remeron also has a 5ht and NE reuptake inhibition
Posted by McPac on May 2, 2003, at 19:04:11
In reply to Re: Can Anybody help answer this question?, posted by Caleb462 on May 2, 2003, at 2:48:22
All these technical details and terms confuse my poor little brain!
Posted by McPac on May 2, 2003, at 19:43:22
In reply to Re: Can Anybody help answer this question?, posted by cybercafe on May 2, 2003, at 2:50:31
I guess I'm still left wondering if it is possible to predict, from looking at my previously posted characteristics of these 2 meds, what exactly will be the effects of taking them both at the same time........it seems that an antagonist would counteract, or work against, another med's actions at certain sites....so if one med is supposed to do something at a site, and then you take another med that is going to counter that effect, you'll get one med blocking the other med's effect at certain sites.....which could be both GOOD in some cases and BAD in others....i.e., if one med works against a desired, positive effect, then that's BAD, yet if it works against a negative side effect, then that's good......if this doesn't make sense then the h@ll with it, lol.......it would just be nice to be able to predict what 2 combined meds effects would be by looking at each one's mechanisms of action......I'm sure it can be done fairly accurately but I can't stand trying to do it, way too much technical crap, I need plain English, lol
Posted by Ritch on May 3, 2003, at 0:13:40
In reply to Re: Can Anybody help answer this question?, posted by McPac on May 2, 2003, at 19:43:22
> I guess I'm still left wondering if it is possible to predict, from looking at my previously posted characteristics of these 2 meds, what exactly will be the effects of taking them both at the same time........it seems that an antagonist would counteract, or work against, another med's actions at certain sites....so if one med is supposed to do something at a site, and then you take another med that is going to counter that effect, you'll get one med blocking the other med's effect at certain sites.....which could be both GOOD in some cases and BAD in others....i.e., if one med works against a desired, positive effect, then that's BAD, yet if it works against a negative side effect, then that's good......if this doesn't make sense then the h@ll with it, lol.......it would just be nice to be able to predict what 2 combined meds effects would be by looking at each one's mechanisms of action......I'm sure it can be done fairly accurately but I can't stand trying to do it, way too much technical crap, I need plain English, lol
I'm not sure about the receptor biz, but if you focus on what works with each individual med and the adverse effects of each then you might see how the combo could be effective despite them seemingly "cancelling' each other. If you got Zoloft first and had trouble sleeping, restlessness, nausea, etc., but otherwise got a good anti-anxiety or antidepressant response from the Zoloft, then Remeron might reduce or reverse all of those adverse effects greatly (if the Remeron add didn't make your anxiety or depression worse and didn't introduce any intolerable adverse effects of its own).
Posted by cybercafe on May 3, 2003, at 1:41:54
In reply to Re: Can Anybody help answer this question?, posted by McPac on May 2, 2003, at 19:43:22
i would predict serotonin syndrome from combining two reuptake inhibitors
may as well just take remeron
> I guess I'm still left wondering if it is possible to predict, from looking at my previously posted characteristics of these 2 meds, what exactly will be the effects of taking them both at the same time........it seems that an antagonist would counteract, or work against, another med's actions at certain sites....so if one med is supposed to do something at a site, and then you take another med that is going to counter that effect, you'll get one med blocking the other med's effect at certain sites.....which could be both GOOD in some cases and BAD in others....i.e., if one med works against a desired, positive effect, then that's BAD, yet if it works against a negative side effect, then that's good......if this doesn't make sense then the h@ll with it, lol.......it would just be nice to be able to predict what 2 combined meds effects would be by looking at each one's mechanisms of action......I'm sure it can be done fairly accurately but I can't stand trying to do it, way too much technical crap, I need plain English, lol
Posted by McPac on May 3, 2003, at 17:44:06
In reply to Re: Can Anybody help answer this question? » McPac, posted by Ritch on May 3, 2003, at 0:13:40
Thanks Ritch!
Posted by McPac on May 3, 2003, at 18:01:22
In reply to Re: Can Anybody help answer this question?, posted by cybercafe on May 3, 2003, at 1:41:54
i would predict serotonin syndrome from combining two reuptake inhibitors
>>>>>>I'd be cutting my Zoloft dose markedly, to accomodate the added Remeron; the totality of the 2 meds would not be an extra large dose at all.
may as well just take remeron>>>>>>I wish it were that easy.....the Zoloft is a PROVEN anti-ocd med for me (but w/ some very detrimental s/e's.....IF I can lower the Z dose, and use add'l Remeron to compensate for the depression that I normally get when lowering the Z dose, I may very well be able to pull this off---I may get enough Z benefit for the ocd, enough depression benefit from the Z and R TOGETHER, and be able to avoid some/many of the s/e's...see how complicated this crap can be, lol! To add further "potential" to this plan, it IS 'possible' (as Remeron does work for SOME for ocd) that I MAY be able to eventually replace the Z with the R completely...
Posted by cybercafe on May 4, 2003, at 13:12:11
In reply to Cyber, Re: Can Anybody help answer this question?, posted by McPac on May 3, 2003, at 18:01:22
> may as well just take remeron
>
> >>>>>>I wish it were that easy.....the Zoloft is a PROVEN anti-ocd med for me (but w/ some very detrimental s/e's.....IF I can lower the Z dose, and use add'l Remeron to compensate for the depression that I normally get when lowering the Z dose, I may very well be able to pull this off---I may get enough Z benefit for the ocd, enough depression benefit from the Z and R TOGETHER, and be able to avoid some/many of the s/e's...see how complicated this crap can be, lol! To add further "potential" to this plan, it IS 'possible' (as Remeron does work for SOME for ocd) that I MAY be able to eventually replace the Z with the R completely...ah, sounds interesting. it may work for you. but i am certainly in no position to give advice on such pharmacodynamics. what does your doctor say? i really wish there were pure 5ht2a antagonists available
Posted by cybercafe on May 4, 2003, at 13:17:57
In reply to Cyber, Re: Can Anybody help answer this question?, posted by McPac on May 3, 2003, at 18:01:22
btw to answer your question... i would imagine that remeron's activity as an antagonist at 5ht2, 5ht3 etc sites would of course continue (it would sit on the receptor and block it without activating it)
so we would have extra serotonin from zoloft blocking 5ht reuptake pumps competing for 5ht2, 5ht3 receptors, extra serotonin from remeron blocking 5ht reuptake pumps competing for 5ht2, 5ht3 receptor sites, and remeron blocking 5ht, 5ht3 receptor sitesso i could be wrong.. but i would imagine it would be like you said, enough 5ht2 5ht3 sites will be blocked to reduce the side effects, but not as much as to totally compensate for the increased serotonin
Posted by McPac on May 4, 2003, at 23:38:56
In reply to Re: Cyber, Re: Can Anybody help answer this question?, posted by cybercafe on May 4, 2003, at 13:17:57
nm
This is the end of the thread.
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