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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Jerseygal on April 23, 2011, at 16:55:15
I have a few questions regarding the combo of lexapro and remeron. I was on prozac for many years until it pooped out about a year ago. I am now taking 40 mg. lexapro and 30 mg. remeron. I started taking the remeron in Nov. 2010 and lexapro at the end of January 2011. Though I am feeling somewhat better, I am still having issues with anxiety and obsessive thinking. I was wondering if the remeron could possibly be cancelling out some of the benefits of lexapro? I know that remeron acts on different receptors depending on the dose. Would it be worth trying remeron at 15 mg. to see if it makes a difference? I guess what I'm getting at is that I wonder if I'm on too much medication at this point.
Posted by bleauberry on April 23, 2011, at 19:01:01
In reply to Remeron and Lexapro combo not working, posted by Jerseygal on April 23, 2011, at 16:55:15
If it were me I would try for 15mg because it has less stimulation at that dose. Or briefly try going to 45mg just to see what happens. If things get worse, then you'll know it has to go the other direction. But it might get better instead. Know way to know.
I don't have a whole lot of faith in remeron other than as a sleeping medicine at super low doses where it works great for that. Sometimes though it does work good for some people.
The TCAs I think have more potential to do what you need. I was thinking of things like Nortriptyline or Amitriptyline. Combined with lexapro. This would be to replace remeron or possibly go with it in a 3 way cocktail.
In the meantime I think it is helpful to address the symptoms in the short run, so as to halt any progression of further stressing on the mind and body. And work on longer term strategies to replace the short term ones. Short term would include something that acts fast on your symptoms to be used on an as needed basis. I guess I'm probably thinking of Xanax or Ativan or Klonopin. Probably xanax since the others have more of a reputation of worsening depression.
I guess an antipsychotic is an option too. Either for as needed relief of longer term. Zyprexa first choice, as low as 2.5mg or cut it in half for 1.25mg. Maybe higher if you like.
Just some things to consider.
Posted by Jerseygal on April 23, 2011, at 21:36:03
In reply to Re: Remeron and Lexapro combo not working, posted by bleauberry on April 23, 2011, at 19:01:01
Thanks for your input. I have tried some of the things you suggested without any luck. My doc tried to increase remeron to 45 mg. and I found it to be too stimulating - waking up during the night, more anxiety etc. I have also tried abilify and seroquel. I take klonopin but at a fairly low dose - only .25-.5 mg. per day. You're right that the symptoms stress the mind and body. The one good thing about remeron is that I sleep well so I can get some rest from the symptoms. I think that it probably can't hurt to try remeron at 15 mg. and see what happens.
Posted by mtdewcmu on April 27, 2011, at 18:58:40
In reply to Remeron and Lexapro combo not working, posted by Jerseygal on April 23, 2011, at 16:55:15
If you have not yet tried Zoloft, I would recommend giving it a try. Stop Lexapro and start Zoloft. You may also be able to go back to Prozac and have it work. You can decrease Remeron to 15mg, but I doubt it will make a huge difference.
Posted by SLS on April 27, 2011, at 19:55:42
In reply to Remeron and Lexapro combo not working, posted by Jerseygal on April 23, 2011, at 16:55:15
> I have a few questions regarding the combo of lexapro and remeron. I was on prozac for many years until it pooped out about a year ago. I am now taking 40 mg. lexapro and 30 mg. remeron. I started taking the remeron in Nov. 2010 and lexapro at the end of January 2011. Though I am feeling somewhat better, I am still having issues with anxiety and obsessive thinking. I was wondering if the remeron could possibly be cancelling out some of the benefits of lexapro? I know that remeron acts on different receptors depending on the dose. Would it be worth trying remeron at 15 mg. to see if it makes a difference? I guess what I'm getting at is that I wonder if I'm on too much medication at this point.
It is my impression that Remeron works best at dosages of 45-75 mg to treat more severe depressions. In Europe, doctors often target 60mg first as a therapeutic dosage.
- Scott
Posted by Jerseygal on April 29, 2011, at 16:16:21
In reply to Re: Remeron and Lexapro combo not working » Jerseygal, posted by mtdewcmu on April 27, 2011, at 18:58:40
Thanks for your input. When I see my pdoc, I'm going to ask about trying zoloft next.
Posted by Jerseygal on April 29, 2011, at 16:20:08
In reply to Re: Remeron and Lexapro combo not working » Jerseygal, posted by SLS on April 27, 2011, at 19:55:42
Thanks for your response. It's interesting to learn about the use of higher remeron dosages in Europe. I did briefly try increasing remeron to 45 mg. but then found I couldn't sleep as well. I don't know if I gave it enough time at the higher dose as it was only a few days and then I got scared because I wasn't sleeping well. There's nothing worse than not being able to sleep when you feel terrible to begin with.
Posted by mtdewcmu on April 29, 2011, at 17:31:33
In reply to Re: Remeron and Lexapro combo not working » Jerseygal, posted by SLS on April 27, 2011, at 19:55:42
>
> It is my impression that Remeron works best at dosages of 45-75 mg to treat more severe depressions. In Europe, doctors often target 60mg first as a therapeutic dosage.
>
>
> - ScottThat is surprising. I wonder why the maximum dose in the US is set at 45 mg. Doctors tend to rely on the official max to guide their prescribing.
Posted by SLS on April 29, 2011, at 19:17:01
In reply to Re: Remeron and Lexapro combo not working, posted by Jerseygal on April 29, 2011, at 16:20:08
> Thanks for your response. It's interesting to learn about the use of higher remeron dosages in Europe. I did briefly try increasing remeron to 45 mg. but then found I couldn't sleep as well. I don't know if I gave it enough time at the higher dose as it was only a few days and then I got scared because I wasn't sleeping well. There's nothing worse than not being able to sleep when you feel terrible to begin with.
I know insomnia can be torturous. However, it can also be an indication that you were just reaching a therapeutic dosage of Remeron. If at some point in the future, you decide to revisit Remeron, then you are going to need to treat the insomnia aggressively as you titrate to 45-75 mg. For me, insomnia is a good sign that I am about to respond to treatment. I can't guarantee that this will be the case for you. However, if insomnia is the only thing standing in your way to increase the dosage of Remeron, then I believe this should be treatable. I am not recommending you self-medicate, but I would bring this strategy up with your doctor.
- Scott
Posted by SLS on April 29, 2011, at 19:32:11
In reply to Re: Remeron and Lexapro combo not working » SLS, posted by mtdewcmu on April 29, 2011, at 17:31:33
> >
> > It is my impression that Remeron works best at dosages of 45-75 mg to treat more severe depressions. In Europe, doctors often target 60mg first as a therapeutic dosage.
> >
> >
> > - Scott
>
> That is surprising. I wonder why the maximum dose in the US is set at 45 mg.I have never been sure why the manufacturer recommends such low dosages. Perhaps they were looking to establish a dosage range that would produce the least burden of side effects in order to advertise. European psychiatrists had over a decade of a head start in using NaSSA drugs with the advent of mianserin in the early 1980s. I believe that their experience with mianserin allowed them to be less afraid to push the dosage of mirtazapine.
- Scott
Posted by Jerseygal on May 1, 2011, at 16:56:39
In reply to Re: Remeron and Lexapro combo not working » Jerseygal, posted by SLS on April 29, 2011, at 19:17:01
I never thought about it that way - that the insomnia could be a good sign. I will bring it up with my doc at my next visit. I almost wish I had tried remeron on its own to see if it would work. I went from being on prozac which pooped out (tried to stop and restart it and that didn't help). Then, remeron was added to see if it would boost the prozac, and to help with sleep. That didn't work so I was switched from prozac to lexapro with the continuance of remeron. This combo hasn't worked yet (it's been three months with increases in lexapro every month). Will have to see where I go from here if this last increase in lexapro doesn't work as I am at the highest dose my pdoc will prescribe.
This is the end of the thread.
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