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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 Kroserob on June 13, 2004, at 18:50:41
Hi, I'm taking Remeron for appetite stimulation. I've tried 7.5 and 15 mg, not much difference in the effects, marked carb cravings for the first month, and sedation.
Now after a month the appetite stimulation is tapering off. I understand that the side effects may be inversely proportionate to dosage, so I'm not sure I should increase the dosage.
If the serotonin receptors become saturated, might it be a good idea to go off it completely for a short time and then restart, to "reset" the receptors?
I'd like to understand the mechanism of this appetite stimulation.. is it the inhibition of the serotonin-2 receptors? And how do you maintain the optimal level over time?
Thanks in advance!
Posted by Shawn. T. on June 14, 2004, at 7:45:29
In reply to Remeron for appetite increase, posted by Kroserob on June 13, 2004, at 18:50:41
The appetite increase is most strongly induced by mirtazapine's 5-HT2C receptor antagonist activity. See http://www.neurotransmitter.net/mirtazapineweight.html and http://www.sciencemag.org/cgi/content/full/297/5581/609 ... inhibition of alpha-MSH and perhaps beta-MSH release secondary to 5-HT2C antagonism is a likely explanation for mirtazapine- induced hyperphagia. Histamine H1 receptor antagonism could play some role as well. I doubt that 5-HT2C receptor saturation is involved in the tolerance that you are experiencing; saturation does not take weeks to set in, and your brain adapts to drugs like Remeron on many different levels. At this point, I don't think that sufficient evidence exists to suggest why the tolerance sets in. Some people don't seem to experience a tapering off of appetite stimulation with Remeron at all, so genetic factors are probably involved to some degree. The only way to determine if a short drug holiday would help would be to try it out; the key downside to your approach would probably involve an increase in sedation.
Shawn
Posted by Sad Panda on June 14, 2004, at 7:56:09
In reply to Remeron for appetite increase, posted by Kroserob on June 13, 2004, at 18:50:41
> Hi, I'm taking Remeron for appetite stimulation. I've tried 7.5 and 15 mg, not much difference in the effects, marked carb cravings for the first month, and sedation.
>
> Now after a month the appetite stimulation is tapering off. I understand that the side effects may be inversely proportionate to dosage, so I'm not sure I should increase the dosage.
>
> If the serotonin receptors become saturated, might it be a good idea to go off it completely for a short time and then restart, to "reset" the receptors?
>
> I'd like to understand the mechanism of this appetite stimulation.. is it the inhibition of the serotonin-2 receptors? And how do you maintain the optimal level over time?
>
> Thanks in advance!
>Hi,
Unfortunately, you can't rely on Remeron to be a permanent appetite stimulant as this is an effect that fades. Only 50% of takers actually experience it & a smaller propotion gain significant weight.
Cheers,
Panda.
Posted by Kroserob on June 14, 2004, at 8:44:58
In reply to Re: Remeron for appetite increase, posted by Sad Panda on June 14, 2004, at 7:56:09
Thanks for the good info, Shawn and Panda. I guess I'll need to play around with it a bit. I think I've exhausted the other drugs that have weight gain as a side effect, having tried some with no effect and ruling out others..
For example, my doctor suggested I could try Zyprexa, only because she knows it causes weight gain.. I looked up the mechanism and it seems to cause weight gain by inducing insulin resistance not by increasing appetite. So my guess is that it causes you to store fat more easily although you're not actually stimulated to eat more. So that's not exactly what I need.
The SSRI's I tried all made me nauseous, so I don't think I'm a candidate for trying any others of that class. If anyone has any other ideas of ways to use any AD drugs (or anything else) for appetite stimulation, please let me know.
Thanks again.
K.
Posted by Racer on June 14, 2004, at 11:17:44
In reply to Re: Remeron for appetite increase, posted by Kroserob on June 14, 2004, at 8:44:58
Periactin is an old fashioned anti-histimine that is used to combat anorexia caused by other drugs -- like HIV drugs and chemotherapy -- as well as some of the side effects of SSRIs, etc. (It's useful for a lot of people for the anorgasmia from SSRIs, for instance.) The benefits of periactin are that it's cheap -- long been generic -- short acting, so there aren't a lot of long term problems, and if it works, it really seems to work.
That's the only thing I can think of.
Good luck.
Posted by Kroserob on June 14, 2004, at 12:05:27
In reply to Periactin? » Kroserob, posted by Racer on June 14, 2004, at 11:17:44
Thanks, now I remember I tried Periactin a while back, but I might not have taken enough.. might be something to reconsider. I wonder why only a few antihistamines have the appetite stimulating effect, whereas common ones like Benadryl don't..?
Thanks again,
K.
Posted by Sad Panda on June 16, 2004, at 1:25:26
In reply to Re: Periactin? » Racer, posted by Kroserob on June 14, 2004, at 12:05:27
> Thanks, now I remember I tried Periactin a while back, but I might not have taken enough.. might be something to reconsider. I wonder why only a few antihistamines have the appetite stimulating effect, whereas common ones like Benadryl don't..?
>
> Thanks again,
> K.
>Periactin anatagonises 5-HT2C as does Remeron. 5-HT2C antagonism is said to increase appetite, while agonism by increases in serotonin levels reduces it. A defective 5-HT2C gene could be reasponsible for under- & over-eaters, do you have an illness or a lifelong problem?
Cheers,
Panda.
Posted by Kroserob on June 16, 2004, at 5:36:27
In reply to Re: Periactin? » Kroserob, posted by Sad Panda on June 16, 2004, at 1:25:26
> Periactin anatagonises 5-HT2C as does Remeron. 5-HT2C antagonism is said to increase appetite, while agonism by increases in serotonin levels reduces it. A defective 5-HT2C gene could be reasponsible for under- & over-eaters, do you have an illness or a lifelong problem?
Lifelong since early 20's, which is 30 years, but hints of it as early as age 8. My suspicion is that early childhood factors could have damaged the genetic structure, such as trauma or toxic exposures, but that's just a strong intuitive sense I get from living in my body all these years, and it's hard to form any sound theory.
K.
Posted by Sad Panda on June 16, 2004, at 23:41:47
In reply to Re: Periactin? » Sad Panda, posted by Kroserob on June 16, 2004, at 5:36:27
> > Periactin anatagonises 5-HT2C as does Remeron. 5-HT2C antagonism is said to increase appetite, while agonism by increases in serotonin levels reduces it. A defective 5-HT2C gene could be reasponsible for under- & over-eaters, do you have an illness or a lifelong problem?
>
>
> Lifelong since early 20's, which is 30 years, but hints of it as early as age 8. My suspicion is that early childhood factors could have damaged the genetic structure, such as trauma or toxic exposures, but that's just a strong intuitive sense I get from living in my body all these years, and it's hard to form any sound theory.
> K.
>
>My social anxiety & overeating habits began when I was around 7-8yo too. Remeron actually reduces my binge eating, my pdoc wants me to take less Remeron but when I do I don't sleep properly which darkens my mood & makes me binge.
Cheers,
Panda.
This is the end of the thread.
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