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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by MoBe on December 27, 2009, at 0:57:18
I have been on mirtazapine, the generic form of Remeron for quite some time now. However, lately, I have developed some strange "mouth" symptoms. My mouth sometimes feels dry, and my gums feel swollen. I find this particularly odd because although I've had a somewhat dry mouth, it has been tolerable. Within the last 6 months, it has become almost unbearable. My gums feel swollen and tongue has a white coat to it. I've gone through I don't know how many dry mouth products without much success. Neither my dentist nor my Doctor have been able to offer any suggestions that offer sustained releif. Other than discontinuing the medication, which I am reluctant to do because it helps me sleep so well; does anyone have any other suggestions?
Posted by bleauberry on December 27, 2009, at 6:13:12
In reply to Remeron and mouth symptoms, posted by MoBe on December 27, 2009, at 0:57:18
"mouth symptoms"; "white coating on tongue"; "gums feel swollen".
Excellent description.
Many doctors do not give it credence as a bonafide condition. But all over the internet are thousands of stories of candida overgrowth, symptoms, signs, causes, and cures. Out of the 10 or so doctors I have seen in the last 15 years, only 3 of them rated this a very common undiagnosed condition especially when psychiatric symptoms are present as well. In a number of case studies, candida itself turned out to be the cause of the depression in the first place. Dealing with it allowed the successful weaning off antidepressants.
I am not at all suggesting that path, only to say that what you have described is fairly classic of yeast/fungal overgrowth. The causes are dry mouth, sugars in the diet, and stress, all of which give the normal populations of yeast an advantage in setting up shop. Normally our own friendly bacteria keep them in small numbers. But they are highly opportunistic. Give them an inch they'll take a mile.
No one has ever studied what various psych drugs do to our friendly bacteria in the intestines that keep yeast in small populations. Is remeron toxic to our friendly gut flora? No way to know. Is it helpful to them? I doubt that very much. But we don't know.
If my take is correct, a formal lab diagnosis is not easy. There is a test that measures byproducts of yeast in the urine. Elevated amounts are present when there is a problem, only miniscule amounts when not. Diagnosis is usually an educated hunch or clinical symptoms. The white coating by itself pretty much nails it.
Doctors who don't believe are under the misguided assumption that yeast only shows up as a diaper rash, vaginal infection, or jock itch? It can't happen anywhere else? Give me a break. It can't happen in the mouth? The intestines? Throughout the bloodstream? The brain? How do they know? They don't. The ones that do know are very aware of all these things and the crippling wide ranging symptoms.
Here's an easy test you can do. I really don't know the accuracy of it, except that when I had suspected candida the test was definitely positive, and after I had been on garlic and diflucan for a couple weeks, all signs of candida were completely gone. The test. First thing in the morning out of bed, spit into a glass of water. Normal spit should just float on top of the water. Candida spit will develop milky trails sinknig to the bottom of the glass. It will happen anywhere from immediately to a few minutes. They will look like curtains or strings. The more there is, the thicker they are, the worse the infection. Normal spit will still be sitting there on top of the water for a long time, with no milky trails.
Curing the problem is a challenge, because candida is an extremely rapid multiplier and quite tenacious once it has been established. It takes a comprehensive attack with meds, herbs, and diet to really knock it out for good.
For meds, you want Diflucan first choice, Diflucan and Nystatin second choice, Nystatin alone third choice. For herbs you want Oil of Oregano, garlic extracts WITH the odor (not the de-odorized ones), or a raw garlic clove chewed up (not cooked) each night, grapefruit seed extract, pau d'arco tea, caprylic acid, or any combination. The meds work best with any of the herbs added.
You probably had a candida situation all along. The dry mouth from remeron made it easy for the good bacteria to die off and easy for candida to take over.
For diet it will be important to avoid all forms of sugar and artificial sugar (except Stevia), for a month or so to really kill this thing.
Taking a high dose high quality refrigerated probiotic every day is paramount. You can even open a capsule, mix the powder in water, and swish it around in your mouth before swallowing so as to give the good bacteria an immediate deposit in their new home (your mouth). One of their functions is to provide a barrier and a defense from candida taking over. The rest will do their magic in your intestines, where the problem is probably even worse than your mouth.
This is not just a dry mouth thing. Most people who had candida and got rid of it report significant improvements in mood, energy, clear headedness, and sleep.
If your doctor doesn't know about it or agree with it, just politely request several weeks of Diflucan for a trial. There is on harm in that and no reason not to. If he refuses, you can do two things. First, realize you probably need a more up-to-date doctor. Second, you have some very potent herbs at our disposal.
Once this thing is knocked down, it will be very important to continue with the probiotics every day, and to only consume small amounts of sugar. You'll have to always be aware that the dry mouth is going to give them an opportune place to come back, so probiotics and low sugar will keep that from happening again.
> I have been on mirtazapine, the generic form of Remeron for quite some time now. However, lately, I have developed some strange "mouth" symptoms. My mouth sometimes feels dry, and my gums feel swollen. I find this particularly odd because although I've had a somewhat dry mouth, it has been tolerable. Within the last 6 months, it has become almost unbearable. My gums feel swollen and tongue has a white coat to it. I've gone through I don't know how many dry mouth products without much success. Neither my dentist nor my Doctor have been able to offer any suggestions that offer sustained releif. Other than discontinuing the medication, which I am reluctant to do because it helps me sleep so well; does anyone have any other suggestions?
Posted by Phillipa on December 27, 2009, at 10:40:29
In reply to Re: Remeron and mouth symptoms, posted by bleauberry on December 27, 2009, at 6:13:12
Do you also have dry eyes? Phillipa
Posted by MoBe on December 27, 2009, at 14:33:27
In reply to Re: Remeron and mouth symptoms, posted by Phillipa on December 27, 2009, at 10:40:29
> Do you also have dry eyes? Phillipa
I do have dry eyes. My doctor has checked me for Shogrens (Probably wrong spelling) and both a periodontist and my family doc has said it isn't a yeast infection. Without that diagnosis he would not give me any antibiotics. What has bewildered me is that the coated tongue and dry mouth have escalated lately. I can certainly do some of the natural things; but I doubt I'll get my hands on that antibiotic. I have read that giving up milk can clear up the tongue. Has anyone else read or tried this?
Posted by MoBe on December 27, 2009, at 14:38:14
In reply to Re: Remeron and mouth symptoms, posted by bleauberry on December 27, 2009, at 6:13:12
> "mouth symptoms"; "white coating on tongue"; "gums feel swollen".
>
> Excellent description.
>
> Many doctors do not give it credence as a bonafide condition. But all over the internet are thousands of stories of candida overgrowth, symptoms, signs, causes, and cures. Out of the 10 or so doctors I have seen in the last 15 years, only 3 of them rated this a very common undiagnosed condition especially when psychiatric symptoms are present as well. In a number of case studies, candida itself turned out to be the cause of the depression in the first place. Dealing with it allowed the successful weaning off antidepressants.
>
> I am not at all suggesting that path, only to say that what you have described is fairly classic of yeast/fungal overgrowth. The causes are dry mouth, sugars in the diet, and stress, all of which give the normal populations of yeast an advantage in setting up shop. Normally our own friendly bacteria keep them in small numbers. But they are highly opportunistic. Give them an inch they'll take a mile.
>
> No one has ever studied what various psych drugs do to our friendly bacteria in the intestines that keep yeast in small populations. Is remeron toxic to our friendly gut flora? No way to know. Is it helpful to them? I doubt that very much. But we don't know.
>
> If my take is correct, a formal lab diagnosis is not easy. There is a test that measures byproducts of yeast in the urine. Elevated amounts are present when there is a problem, only miniscule amounts when not. Diagnosis is usually an educated hunch or clinical symptoms. The white coating by itself pretty much nails it.
>
> Doctors who don't believe are under the misguided assumption that yeast only shows up as a diaper rash, vaginal infection, or jock itch? It can't happen anywhere else? Give me a break. It can't happen in the mouth? The intestines? Throughout the bloodstream? The brain? How do they know? They don't. The ones that do know are very aware of all these things and the crippling wide ranging symptoms.
>
> Here's an easy test you can do. I really don't know the accuracy of it, except that when I had suspected candida the test was definitely positive, and after I had been on garlic and diflucan for a couple weeks, all signs of candida were completely gone. The test. First thing in the morning out of bed, spit into a glass of water. Normal spit should just float on top of the water. Candida spit will develop milky trails sinknig to the bottom of the glass. It will happen anywhere from immediately to a few minutes. They will look like curtains or strings. The more there is, the thicker they are, the worse the infection. Normal spit will still be sitting there on top of the water for a long time, with no milky trails.
>
> Curing the problem is a challenge, because candida is an extremely rapid multiplier and quite tenacious once it has been established. It takes a comprehensive attack with meds, herbs, and diet to really knock it out for good.
>
> For meds, you want Diflucan first choice, Diflucan and Nystatin second choice, Nystatin alone third choice. For herbs you want Oil of Oregano, garlic extracts WITH the odor (not the de-odorized ones), or a raw garlic clove chewed up (not cooked) each night, grapefruit seed extract, pau d'arco tea, caprylic acid, or any combination. The meds work best with any of the herbs added.
>
> You probably had a candida situation all along. The dry mouth from remeron made it easy for the good bacteria to die off and easy for candida to take over.
>
> For diet it will be important to avoid all forms of sugar and artificial sugar (except Stevia), for a month or so to really kill this thing.
>
> Taking a high dose high quality refrigerated probiotic every day is paramount. You can even open a capsule, mix the powder in water, and swish it around in your mouth before swallowing so as to give the good bacteria an immediate deposit in their new home (your mouth). One of their functions is to provide a barrier and a defense from candida taking over. The rest will do their magic in your intestines, where the problem is probably even worse than your mouth.
>
> This is not just a dry mouth thing. Most people who had candida and got rid of it report significant improvements in mood, energy, clear headedness, and sleep.
>
> If your doctor doesn't know about it or agree with it, just politely request several weeks of Diflucan for a trial. There is on harm in that and no reason not to. If he refuses, you can do two things. First, realize you probably need a more up-to-date doctor. Second, you have some very potent herbs at our disposal.
>
> Once this thing is knocked down, it will be very important to continue with the probiotics every day, and to only consume small amounts of sugar. You'll have to always be aware that the dry mouth is going to give them an opportune place to come back, so probiotics and low sugar will keep that from happening again.
>
>
> > I have been on mirtazapine, the generic form of Remeron for quite some time now. However, lately, I have developed some strange "mouth" symptoms. My mouth sometimes feels dry, and my gums feel swollen. I find this particularly odd because although I've had a somewhat dry mouth, it has been tolerable. Within the last 6 months, it has become almost unbearable. My gums feel swollen and tongue has a white coat to it. I've gone through I don't know how many dry mouth products without much success. Neither my dentist nor my Doctor have been able to offer any suggestions that offer sustained releif. Other than discontinuing the medication, which I am reluctant to do because it helps me sleep so well; does anyone have any other suggestions?
>
> Thank you for all the information. Both my doctor and my periodontist do not think it is yeast. I have asked. Without the diagnosis, I don't think I can get my hands on an antibiotic for fungal infection. However, I can get my hands on Nystatin for the fungal infections "down below". I don't think I can use this for oral care. However, I will be able to try many of your suggestions. The probiotics will be easy, the giving up of sugar also easy. I will investigate getting my hands on the other items. Thanks again for your help.
Posted by Phillipa on December 27, 2009, at 20:14:13
In reply to Re: Remeron and mouth symptoms » Phillipa, posted by MoBe on December 27, 2009, at 14:33:27
Yup the Sjournes was what I was thinking???? Phillipa ps glad that was negative!!!!
Posted by mtdewcmu on January 1, 2010, at 7:37:21
In reply to Remeron and mouth symptoms, posted by MoBe on December 27, 2009, at 0:57:18
You're almost certainly dealing with anticholinergic side effects from the Remeron (and/or some other med you are taking). A lot of psychiatric drugs do this. Maybe you could get the doctor to prescribe you a drug for dry mouth like cevimeline or pilocarpine. Keep us posted.
Posted by MoBe on January 1, 2010, at 13:20:32
In reply to Re: Remeron and mouth symptoms, posted by mtdewcmu on January 1, 2010, at 7:37:21
> You're almost certainly dealing with anticholinergic side effects from the Remeron (and/or some other med you are taking). A lot of psychiatric drugs do this. Maybe you could get the doctor to prescribe you a drug for dry mouth like cevimeline or pilocarpine. Keep us posted.
Yes, I agree with you that it is likely it is the Remeron, although the dry mouth side effect didn't appear in full force and was manageable for the last 10 years. I've asked for pilocarpine, a saliva stimulant and my family doc has refused, saying it causes side effects. I've offered that I am willing to try but unfortunately he isn't. What is quite odd, is that even when I have discontinued the remeron for 2 weeks the problem doesn't resolve itself. The doc said pilocarpine would make me tired. I've read that it makes you sweat more, tear more and nose drip more but not so much tiredness. Maybe I can plead with him. Oh brother!!!!!
Thanks.
Mobe
Posted by mtdewcmu on January 1, 2010, at 22:24:01
In reply to Re: Remeron and mouth symptoms » mtdewcmu, posted by MoBe on January 1, 2010, at 13:20:32
> > You're almost certainly dealing with anticholinergic side effects from the Remeron (and/or some other med you are taking). A lot of psychiatric drugs do this. Maybe you could get the doctor to prescribe you a drug for dry mouth like cevimeline or pilocarpine. Keep us posted.
>
> Yes, I agree with you that it is likely it is the Remeron, although the dry mouth side effect didn't appear in full force and was manageable for the last 10 years. I've asked for pilocarpine, a saliva stimulant and my family doc has refused, saying it causes side effects. I've offered that I am willing to try but unfortunately he isn't. What is quite odd, is that even when I have discontinued the remeron for 2 weeks the problem doesn't resolve itself. The doc said pilocarpine would make me tired. I've read that it makes you sweat more, tear more and nose drip more but not so much tiredness. Maybe I can plead with him. Oh brother!!!!!
>
> Thanks.
>
> MobeIf you have stopped the Remeron for 2 weeks and it hasn't resolved, then I don't see how it could be the Remeron. Remeron doesn't remain in the body that long.
Posted by mtdewcmu on January 1, 2010, at 22:27:43
In reply to Re: Remeron and mouth symptoms, posted by mtdewcmu on January 1, 2010, at 22:24:01
Are you taking any other medications that could be causing it?
What kind of doctor did you see about it? A psychiatrist or a regular doctor? If you have seen a regular doctor about it, maybe you should see a specialist.
Posted by MoBe on January 2, 2010, at 17:21:10
In reply to Re: Remeron and mouth symptoms, posted by mtdewcmu on January 1, 2010, at 22:27:43
> Are you taking any other medications that could be causing it?
>
> What kind of doctor did you see about it? A psychiatrist or a regular doctor? If you have seen a regular doctor about it, maybe you should see a specialist.I saw a family doc. I work at the local hospital and know of most of the psych docs. Many of them are reluctant to give out meds. I think the pendulum has started to move the other way in favour of not medicating the patient. I can understand this to a degree because polypharmacy can create a real mess; and certainly some patients do not participate in their own care as much as possible. There is a walk in doctor, however that belongs to our local mental health team. Maybe I will try him.
Most of the meds I'm on can cause some degree of dry mouth. They are prometrium 100 mg, methylphenidate 10 mg TID, mirtazapine 4 mg at night, synthroid 50 mcg, cytomel 25 mcg. The doc just discontinued my cytomel because my TSH was low and my free T3 was high. However because my free T4 was slightly low he marginaly increased the synthroid.
Thanks for your input.
Mobe
Posted by MoBe on January 2, 2010, at 17:24:33
In reply to Re: Remeron and mouth symptoms, posted by mtdewcmu on January 1, 2010, at 22:24:01
> > > You're almost certainly dealing with anticholinergic side effects from the Remeron (and/or some other med you are taking). A lot of psychiatric drugs do this. Maybe you could get the doctor to prescribe you a drug for dry mouth like cevimeline or pilocarpine. Keep us posted.
> >
> > Yes, I agree with you that it is likely it is the Remeron, although the dry mouth side effect didn't appear in full force and was manageable for the last 10 years. I've asked for pilocarpine, a saliva stimulant and my family doc has refused, saying it causes side effects. I've offered that I am willing to try but unfortunately he isn't. What is quite odd, is that even when I have discontinued the remeron for 2 weeks the problem doesn't resolve itself. The doc said pilocarpine would make me tired. I've read that it makes you sweat more, tear more and nose drip more but not so much tiredness. Maybe I can plead with him. Oh brother!!!!!
> >
> > Thanks.
> >
> > Mobe
>
> If you have stopped the Remeron for 2 weeks and it hasn't resolved, then I don't see how it could be the Remeron. Remeron doesn't remain in the body that long.Yes, I agree. I have discontinued the Remeron for 2 weeks and the dry mouth did not go away. Then I put myself back on it and discontinued the prometrium for 2 weeks and it also did not go away. I wonder if there is something I'm missing. I don't want to discontinue the methylphenidate as my brain goes into a fog without it. The thyroid meds would probably be dangerous to discontinue.
Thanks.
Mobe
Posted by mtdewcmu on January 2, 2010, at 17:45:24
In reply to Re: Remeron and mouth symptoms » mtdewcmu, posted by MoBe on January 2, 2010, at 17:24:33
> > > > You're almost certainly dealing with anticholinergic side effects from the Remeron (and/or some other med you are taking). A lot of psychiatric drugs do this. Maybe you could get the doctor to prescribe you a drug for dry mouth like cevimeline or pilocarpine. Keep us posted.
> > >
> > > Yes, I agree with you that it is likely it is the Remeron, although the dry mouth side effect didn't appear in full force and was manageable for the last 10 years. I've asked for pilocarpine, a saliva stimulant and my family doc has refused, saying it causes side effects. I've offered that I am willing to try but unfortunately he isn't. What is quite odd, is that even when I have discontinued the remeron for 2 weeks the problem doesn't resolve itself. The doc said pilocarpine would make me tired. I've read that it makes you sweat more, tear more and nose drip more but not so much tiredness. Maybe I can plead with him. Oh brother!!!!!
> > >
> > > Thanks.
> > >
> > > Mobe
> >
> > If you have stopped the Remeron for 2 weeks and it hasn't resolved, then I don't see how it could be the Remeron. Remeron doesn't remain in the body that long.
>
> Yes, I agree. I have discontinued the Remeron for 2 weeks and the dry mouth did not go away. Then I put myself back on it and discontinued the prometrium for 2 weeks and it also did not go away. I wonder if there is something I'm missing. I don't want to discontinue the methylphenidate as my brain goes into a fog without it. The thyroid meds would probably be dangerous to discontinue.
>
> Thanks.
>
> MobeMy drug book lists dry mouth as a side effect of methylphenidate, but not Cytomel. However, if you are on a tad too much Cytomel, I could see that contributing. You could try gradually reducing your dose of Cytomel and see if that helps. Or you could see a specialist doctor that deals with the mouth (I'm not sure what specialty that would be), and that doctor might be looser with the prescription pad. The pdocs probably don't want to prescribe the meds because they are not familiar enough with them.
PS. Neither the MPH or any of the hormones you're on has anticholinergic side effects that I know of. But MPH is a sympathomimetic and that's the opposite branch of the autonomic nervous system. IIRC, excess thyroid hormones stimulate release of adrenaline, too.
Posted by mtdewcmu on January 2, 2010, at 17:48:51
In reply to Re: Remeron and mouth symptoms, posted by mtdewcmu on January 2, 2010, at 17:45:24
> PS. Neither the MPH or any of the hormones you're on has anticholinergic side effects that I know of. But MPH is a sympathomimetic and that's the opposite branch of the autonomic nervous system. IIRC, excess thyroid hormones stimulate release of adrenaline, too.
Well, actually, I think dry mouth is called an "anticholinergic" side effect regardless of the actual mechanism. But none of the drugs you are on directly antagonise acetylcholine receptors to any great degree.
Posted by Phillipa on January 2, 2010, at 19:29:30
In reply to Re: Remeron and mouth symptoms » mtdewcmu, posted by MoBe on January 2, 2010, at 17:21:10
Promethium? That's bioidentical progesterone? Never heard of that with it and I'm on synthroid l5 years never had it. Still say get checked for Sjournes disease. Not dangerous just dry eyes, mouth etc. Phillipa
Posted by MoBe on January 3, 2010, at 2:23:43
In reply to Re: Remeron and mouth symptoms » MoBe, posted by Phillipa on January 2, 2010, at 19:29:30
> Promethium? That's bioidentical progesterone? Never heard of that with it and I'm on synthroid l5 years never had it. Still say get checked for Sjournes disease. Not dangerous just dry eyes, mouth etc. Phillipa
I did get checked for Sjournes disease and it was negative. I've read posts on other sites where people say that their cytomel can cause dry mouth. But maybe not the synthroid.
Mobe
Posted by MoBe on January 3, 2010, at 2:30:06
In reply to Re: Remeron and mouth symptoms, posted by mtdewcmu on January 2, 2010, at 17:48:51
> > PS. Neither the MPH or any of the hormones you're on has anticholinergic side effects that I know of. But MPH is a sympathomimetic and that's the opposite branch of the autonomic nervous system. IIRC, excess thyroid hormones stimulate release of adrenaline, too.
>
> Well, actually, I think dry mouth is called an "anticholinergic" side effect regardless of the actual mechanism. But none of the drugs you are on directly antagonise acetylcholine receptors to any great degree.I think the thing I find most baffling is that I have been on all these meds for years. However, it has only been recently that my thyroid has swung to the hyperthyroid end. 25 years ago I had radioactive iodine treatment and was in thyroid balance without meds for about 20 of those years. Then I went slightly hypothyroid and the doctor started me first on synthroid and a few years later added the cytomel. Since he has asked me to discontinue the cytomel I will find out soon enough if it is the culprit.
Mobe
Posted by Phillipa on January 3, 2010, at 18:48:34
In reply to Re: Remeron and mouth symptoms » mtdewcmu, posted by MoBe on January 3, 2010, at 2:30:06
Seriously would you let us know? That's interesting. Phillipa
Posted by MoBe on January 3, 2010, at 22:26:26
In reply to Re: Remeron and mouth symptoms, posted by Phillipa on January 3, 2010, at 18:48:34
> Seriously would you let us know? That's interesting. Phillipa
Sure. Share the wealth so to speak.
Take care.
Mobe
This is the end of the thread.
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