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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Beckett on May 25, 2014, at 14:56:40
I am restarting 30 mg of remeron tonight. I had let it lapse because I do lame things like that in the attempt to reduce my medication. Plus, I have been given excellent advice in a few threads here and have not followed any of it. Sorry.
So, when my doc gets back in a month, I want some ideas on what might be a most beneficial combo because remeron does not do it all at all. But it helps.
I can't crunch the pharmaceutical numbers myself. I think with effexor it's called California rocket fuel? Well that would be too strong for me. How would it work with Brintellix? My doc seemed keen on that one. Thank you for any help. Oh, and stimulants are out.
Posted by tom2228 on May 25, 2014, at 16:01:43
In reply to Remeron plus what? Another question, posted by Beckett on May 25, 2014, at 14:56:40
I don't think it would be "too strong".. in fact the combination was found more tolerable than either one alone.
Using Brintellix instead of the Effexor would be similar just less potent on norepineprhine. The combo of Remeron + SSRI or SNRI is a great option and can be customized to inidivudal needs.
Posted by tom2228 on May 25, 2014, at 16:17:47
In reply to Re: Remeron plus what? Another question, posted by tom2228 on May 25, 2014, at 16:01:43
What about modafinil (Provigil)? It could counter some of the sedating side effects (via increasing histamine levels) of the Remeron and contribute antidepressant effects.
Pramipexole? Wellbutrin? Adding a little Abilify? Latuda? Increasing lamictal?
Posted by Christ_empowered on May 25, 2014, at 16:38:17
In reply to Re: Remeron plus what? Another question, posted by tom2228 on May 25, 2014, at 16:17:47
I've been curious about remeron, so I've been reading about it. Here's what I've found...
1) Effexor or Cymbalta--intense. One abstract on using Cymbalta speaks of "alterations in mental state." of course, I wanted this combo :-)
2) wellbutrin--effective. higher response and remission rates than either alone. I would think the wellbutrin would help counteract sedation and weight gain a bit.
3) an SRI--effective. again, higher remission and response rates than either alone. I would think that you might run into apathy and weight gain (?), but maybe not...
4) Abilify--probably best reserved for psychotic depression, bipolar I, and schizo-whatever. The remeron can help counteract agitation and akathisia from the abilify. I would imagine that weight gain would be an issue.
5) other neuroleptics--OK, so there's apparently some research on using judiciously dosed old antipsychotic plus remeron to kinda sorta create an atypical (I guess...). At the very least, there's less akathisia and greater improvement in negative symptoms over just using an old school neuroleptic.
Good luck!
Posted by Christ_empowered on May 25, 2014, at 16:38:55
In reply to Remeron plus what? Another question, posted by Beckett on May 25, 2014, at 14:56:40
ever taken that one?
Posted by Phillipa on May 25, 2014, at 17:41:13
In reply to Tofranil?, posted by Christ_empowered on May 25, 2014, at 16:38:55
I'm curious why is remeron so popular today it seems to me? Phillip
Posted by tom2228 on May 25, 2014, at 17:49:47
In reply to Re: Tofranil?, posted by Phillipa on May 25, 2014, at 17:41:13
> I'm curious why is remeron so popular today it seems to me? Phillip
In the STAR*D it was found to be the most efficacious antidepressant (of the ones tested in that metaanlysis), and it also has a faster onset of action, a unique mechanism, and combines well and tolerably with other antidepressants, and can help with sleep and appetite in the elderly and cancer patients, and help nausea.
Posted by tom2228 on May 25, 2014, at 17:52:14
In reply to Re: Tofranil?, posted by tom2228 on May 25, 2014, at 17:49:47
> > I'm curious why is remeron so popular today it seems to me? Phillip
>
> In the STAR*D it was found to be the most efficacious antidepressant (of the ones tested in that metaanlysis), and it also has a faster onset of action, a unique mechanism, and combines well and tolerably with other antidepressants, and can help with sleep and appetite in the elderly and cancer patients, and help nausea.It is also helpful for people who have tried other standard antidepressants unsuccessfully.
Posted by linkadge on May 25, 2014, at 19:20:32
In reply to Tofranil?, posted by Christ_empowered on May 25, 2014, at 16:38:55
I have taken Effexor and remeron together. I concur with Tom...it is actually less harsh than Remeron alone (at least for me).
The California rocket fuel label is a bit misleading. Effexor isn't terrible noradrenergic until you get to higher doses.
I was taking remeron and Effexor. I am currently taking remeron and luvox. To be honest, I think remeron and Effexor was a bit more effective.
Luvox has its merits but it seems to leave me a bit more flat than Effexor.
Linkadge
Posted by phidippus on May 25, 2014, at 22:18:10
In reply to Remeron plus what? Another question, posted by Beckett on May 25, 2014, at 14:56:40
What symptoms are you trying to treat?
What's your diagnosis?
Eric
Posted by Beckett on May 26, 2014, at 16:18:44
In reply to Re: Remeron plus what? Another question, posted by tom2228 on May 25, 2014, at 16:01:43
Hey, thanks for all the information. I feel more confidant about the treatment direction I'm heading. Restarted remeron last night.
I thought I'd respond in one email.
I haven't tried Tofranil or any TCA yet. But I've been reading about them after your suggestions here and in another thread.
That combining remeron with another Ssri type drug is not harsh is heartening. Thanks again.
Mainly for Eric: BPII depression, anxiety, panic disorder, and social anxiety. SA has never receeded enough to feel o.k. I have done CBT in w/ and w/o meds. It's a bear. I don't think my doctors have understood how bad it is. More than anything, it defines my life. I know that MAOI's might be a way to go, but haven't wanted to try them.
Posted by phidippus on May 26, 2014, at 18:21:01
In reply to Re: Remeron plus what? Another question, posted by Beckett on May 26, 2014, at 16:18:44
Can you tell me the nature of the thoughts you have when you suffer from your social anxiety?
Eric
Posted by Beckett on May 28, 2014, at 18:29:47
In reply to Re: Remeron plus what? Another question » Beckett, posted by phidippus on May 26, 2014, at 18:21:01
> Can you tell me the nature of the thoughts you have when you suffer from your social anxiety?
>
> EricI assume others will discover that I am mentally ill or poor or stupid or a pushover and that they will sense my anxiety. Which is further evidence for mental illness. Etc.
Most panic attacks involve social situations.
I feel I need medical (pharmaceutical) help in addition to CBT. I am just about housebound and beginning to accept this status.
Posted by Phillipa on May 28, 2014, at 20:43:12
In reply to Re: Remeron plus what? Another question » phidippus, posted by Beckett on May 28, 2014, at 18:29:47
Give yourself credit you are still driving by self. That is huge to me. Phillipa
Posted by Beckett on May 28, 2014, at 22:24:23
In reply to Re: Remeron plus what? Another question » Beckett, posted by Phillipa on May 28, 2014, at 20:43:12
I like driving. It's arriving at a destination that's a b*tch. Oddly, I feel safe in my car although I have had a few panic attacks while driving.
But you can go out on your bike and talk to people. So that seems big to me. I used to ride bike. And trail running too.
Posted by Phillipa on May 29, 2014, at 17:53:40
In reply to Re: Remeron plus what? Another question » Phillipa, posted by Beckett on May 28, 2014, at 22:24:23
What pair we are Phillipa
Posted by Beckett on May 29, 2014, at 18:18:52
In reply to Re: Remeron plus what? Another question » Beckett, posted by Phillipa on May 29, 2014, at 17:53:40
Yes :)
Posted by phidippus on May 29, 2014, at 20:03:46
In reply to Re: Remeron plus what? Another question » phidippus, posted by Beckett on May 28, 2014, at 18:29:47
>I assume others will discover that I am mentally ill or poor or stupid or a pushover and that they will sense my anxiety.
Are these thoughts intrusive and reccurent?
Eric
Posted by Beckett on May 31, 2014, at 5:14:35
In reply to Re: Remeron plus what? Another question » Beckett, posted by phidippus on May 29, 2014, at 20:03:46
> >I assume others will discover that I am mentally ill or poor or stupid or a pushover and that they will sense my anxiety.
>
> Are these thoughts intrusive and reccurent?
>
> EricHi Eric,
I'm not sure I understand the terms. I think these thoughts are perhaps both recurrent and intrusive, but I'm not sure. One constant thought is that I am crazy or going crazy. I think about this all day long. But is a symptom of an anxiety disorder recurrent and intrusive thought?
Posted by Phillipa on May 31, 2014, at 20:34:52
In reply to Re: Remeron plus what? Another question, posted by Beckett on May 31, 2014, at 5:14:35
First thinking you could be crazy or going crazy means you are not crazy as if you were you wouldn't know it. I feel it's severe anxiety. Phillipa
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