Psycho-Babble Medication Thread 1428

Shown: posts 1 to 22 of 22. This is the beginning of the thread.

 

Toby, last posting disappeared to November Archive

Posted by DL on December 1, 1998, at 22:16:00

My last post moved back to the November archive. Tonight I wish I could take it back......Pandora's box is neatly shut and packed away again.

 

Re: Things

Posted by Toby on December 3, 1998, at 16:34:46

In reply to Toby, last posting disappeared to November Archive, posted by DL on December 1, 1998, at 22:16:00

SSRI's are usually dosed quite high for OCD; e.g., for depression the average dose is 20 mg but for OCD it is 60 mg.

Increasing the Remeron to 45 mg may do away with the weight gain. Talk to your doc first.


 

Sorry

Posted by DL on December 4, 1998, at 22:55:51

In reply to Re: Things, posted by Toby on December 3, 1998, at 16:34:46

Sorry for the long rambling complaint message I posted. Sometimes I slip back from the "new me" I'm working on. At this point I think some things are best left in the shadows of the box....I still want to try EMDR but will be ending the better health ins policy with divorce and starting new one that may not cover it. My therapy visits "granted" (what a term to use--sounds like the king bestows them upon us!) on this policy are almost done. I may call and see if they would "grant" some with a diff therapist who does EMDR. I just can't pay for it on my own now and I will need to figure out how to work with the ins co that charges $25/script for Remeron.

 

Re: Things

Posted by DL on December 7, 1998, at 23:38:24

In reply to Re: Things, posted by Toby on December 3, 1998, at 16:34:46

Wish me luck--divorce hearing tomorrow--haven't seen my husband since house closing--not looking forward to seeing him!

The therapist I see is willing to talk to the ins co about EMDR when I find someone. I will make some calls tomorrow after court to see who is available on the list. It's always hard for me to question people about their qualifications. ANd I start feeling that my small issues are not big enough for their expertise.

> Increasing the Remeron to 45 mg may do away with the weight gain. Talk to your doc first.

Are there likely to be other effects from increasing the Remeron? How would I take it? All at night? Or divided? I have been taking all 30mg at night. I have gained a total of 15 lbs! It seems to have slowed or plateaued for a while but the appetite and need to eat is terrible. I am going to find ways to get more exercise into every day. BUt it would be nice if the appetite would decrease.

 

Re: appetite

Posted by Toby on December 10, 1998, at 16:07:05

In reply to Re: Things, posted by DL on December 7, 1998, at 23:38:24

Remeron is usually taken all at night, no matter the dose. It lasts in the system 24 hours, so best to have it all at once. Holidays are bad times to start diets and things, but also nearing time to make resolutions, so maybe starting a little early will help.

Even if your insurance company has no idea what EMDR is, call some of the therapists and talk to them about how they bill insurance. One therapist I know bills it as two separate visits (2 hours) and just never mentions EMDR, only that it is psychotherapy and has never had a problem getting paid.

 

Help for others

Posted by DL on December 10, 1998, at 22:22:54

In reply to Re: appetite, posted by Toby on December 10, 1998, at 16:07:05

Just wanted to pass on to Toby that your caring and knowledgeable messages to me on this board over the last months have apparently helped other people too. I have heard from at least one person who has followed this thread and has enough in common with me to have benefitted from your advise. Especially in this holiday season I feel grateful. Until you helped me I had spent 2 1/2 years in a fruitless search for help. Your messages, carried along to my MD visits, helped to get me on the right track. I have no idea where you find the time to help but I am so glad.

 

Re: Help for others

Posted by Toby on December 11, 1998, at 13:53:51

In reply to Help for others, posted by DL on December 10, 1998, at 22:22:54

Glad to know my thoughts have been helpful for some, less so about those I have irritated with information they didn't really want to hear. I hope for a happy and healthy 1999 for all. My practice is mostly emergency work, so I think I have more "down time" than other docs. That's why I am so annoyingly available. :)

 

Re: Help for others

Posted by DL on December 11, 1998, at 23:10:31

In reply to Re: Help for others, posted by Toby on December 11, 1998, at 13:53:51

> Glad to know my thoughts have been helpful for some, less so about those I have irritated with information they didn't really want to hear. I hope for a happy and healthy 1999 for all. My practice is mostly emergency work, so I think I have more "down time" than other docs. That's why I am so annoyingly available. :)

Who has been irritated? I can't imagine since you are so very careful in what you say. Even when we rant and rave about the drive by prescription pad tx, you never down the MD's. You never insult anyone's intelligence or intuition, and always give a broad spectrum of suggestions. Please don't stop. I wish all the MD's out there were like you. Perhaps they become hardened to mental pain after being overwhelmed RE managed care. Isn't it discouraging that people can connect with mental health care for YEARS and still not have adequate care and evaluation? I wish my MD was as annoyingly available!

QUESTION: in another post you mentioned Effexor for anxiety with depression. How is it different from Remeron? I tried Effexor in a very tiny dose for about 5 days. It was truely terrible--the same type of thing as the SSRI's--racy heart, absolutely no sleep and heightened vigilance. (but I also did not have the klonopin script then either). Note: It's been quite a while since I took the klonopin. Still have some here but haven't needed it since the adjustment after taking Remeron. Remeron didn't really kick in for sleep for the good sleep I have now--for a few weeks.

I hope peace and contentment and creative energy find their homes near you...........


 

Re: Help from Toby

Posted by Nancy on December 13, 1998, at 16:11:13

In reply to Re: Help for others, posted by Toby on December 11, 1998, at 13:53:51

> Glad to know my thoughts have been helpful for some, less so about those I have irritated with information they didn't really want to hear. I hope for a happy and healthy 1999 for all. My practice is mostly emergency work, so I think I have more "down time" than other docs. That's why I am so annoyingly available. :)

Toby, you are the least annoying person that I can imagine. You are extremely and graciously helpful. Thank you, for your professional insight and cited references. Thank you, for the ECT info and the adjunctive meds info, again. I hope that we all get through this year alive.
Nancy

 

Re: Effexor

Posted by Toby on December 14, 1998, at 10:48:33

In reply to Re: Help for others, posted by DL on December 11, 1998, at 23:10:31

Effexor blocks serotonin and norepinephrin reuptake into the neuron (which keeps it in the synapse longer which lets it have more of an effect on the mood receptors). At low doses, it only blocks serotonin reuptake so it acts exactly like an SSRI (which is why it made you feel like the SSRI's did). At medium doses it blocks both serotonin and norepinephrine (and acts like a tricyclic antidepressant) and at very high doses it blocks monoamines like dopamine (so it acts like an MAOI and also like Wellbutrin). So it is a very complex drug and is many drugs in one, depending on the dose.

 

Re: Effexor

Posted by DL on December 14, 1998, at 22:14:28

In reply to Re: Effexor, posted by Toby on December 14, 1998, at 10:48:33

> Effexor blocks serotonin and norepinephrin reuptake into the neuron (which keeps it in the synapse longer which lets it have more of an effect on the mood receptors). At low doses, it only blocks serotonin reuptake so it acts exactly like an SSRI (which is why it made you feel like the SSRI's did). At medium doses it blocks both serotonin and norepinephrine (and acts like a tricyclic antidepressant) and at very high doses it blocks monoamines like dopamine (so it acts like an MAOI and also like Wellbutrin). So it is a very complex drug and is many drugs in one, depending on the dose.

How is Remeron different from these AD's? Is the racy, nervous, jumping out of my skin feeling a normal/expected result of serotonin increase? Or are these side effects of some other mecanism triggered by the drugs? Because Remeron also is supposed to increase serotonin, but as I understand it, it also blocks one kind of serotonin receptor [therefore blocking entry to the receiving cell.]. Even Wellbutrin was very activating for the very short time I took it. Would I have had better results if I took large doses? I guess I don't understand why I had no increase in nervousness and internal shift into high gear if it also increases serotonin.

NOTE: I sent out letters to a number of the people on the EMDR list and hope to hear soon. It is hard to make such calls at work between home visits and it is too late when I get home. Hope I have some responses.

 

EMDR?????

Posted by DL on December 16, 1998, at 21:08:30

In reply to Re: Effexor, posted by DL on December 14, 1998, at 22:14:28

Help, now I'm really nervous! I am used to not getting prompt replies...I wrote some questions to the MD I see twice and never heard back. I sent out letters to 7 people on the EMDR list asking if they take insurance and generally explaining that I would like to try EMDR if they think it is appropriate. The letters would not have gotten there till yesterday and today I had one reply at work and another message when I got home! I don't know any of these people and it makes me really nervous to talk to them. How do I know which person (and I may get more replies) is right? I don't know why I am so nervous.

The person I spoke to is the person who has trained most of the EMDR practicioners in NH. He was part of a research project at Harvard and was out at the Oaklahoma Bombing to direct therapy efforts there for trauma victims. He seemed nice on the phone but told me he no longer struggles with ins. co's--I would have to recoup the money on my own. He did say there were 2 other people in his practice (a Cog Beh practice) whom he has trained that do work with insurance. I asked about billing for 2 therapy visits in one day and he said most ins co won't accept 2 in one day. He gave me the # of the secretary and the name of the other person to contact. My ins will change to a more restrictive one in Jan so I have 2 visits left--one set upthis Sat. with the therapist I have been seeing. She said she would be willingto contact ins co to transfer the visits. If I call and cancel (she is off for the holidays) in the hopes of getting a visit before Jan 1 I may totally lose out. I guess I feel comfortable with her (perhaps since she is comforting but not challenging) and it's scary to move on to something else.

The other person just said he would call back tomorrow (another cog/beh group). I need some support here. It's that old fear of I don't know what-- coming up again. It's terrible. I don't understand why it's so unnerving for me. Some of the problem is the short time to figure this all out. I keep feeling like they will wonder why I'm coming in because I wasn't in a bombing etc. I guess if may be related to that feeling of just not ever measuring up in any way when I was young. Like whatever the qualifications are (trauma?) they I must not be worthy. ??? Help?

 

Re: EMDR?????

Posted by Toby on December 17, 1998, at 9:22:11

In reply to EMDR?????, posted by DL on December 16, 1998, at 21:08:30

Call back both the one who left a message and the secretary for the therapists he referred you to. Ask first if they even have an appointment available before Jan 1. If not, then move on to questions about insurance and what they recommend to facilitate getting a session or two paid for in the new year. If one of them does have an opening, that makes it easier; take it. It'll be OK. don't worry about whether your problem is "worthy;" I promise it is. Don't worry whether you can come up with a "trauma" or not; I once did a session with a man who had what he called "the nameless dread," just a feeling, no trauma that he could remember. He didn't really meet criteria for a "disorder" and he'd been to lots of therapists and doctors and no meds helped. He got referred to me as a last resort, he wasn't very hopeful and thought I was probably a sham artist. We did the procedure anyway and much to his surprise the dread went away. He never did recover any sort of traumatic memory or anything, although he did work through some problems that had been caused by the feeling. I saw his family doctor several months ago and he told me the man was doing well, no meds, working and engaged (hadn't worked or dated in about 7 years). So no problem is too vague or simple to work on. And let me reiterate: I myself was not the miracle worker here; in fact I didn't say more than a dozen words in the whole two hours; the healing came from within the patient and it persists.

 

Re: EMDR?????

Posted by DL on December 17, 1998, at 23:16:28

In reply to Re: EMDR?????, posted by Toby on December 17, 1998, at 9:22:11

Thanks for being there. I spoke to the psychologist who left the message the other day (the other cog beh place). He told me he was trained in EMDR (also at Harvard) and that it could be very effective, although not for everything. He said there are many methods used in therapy and that he would want to interview me before he made the decision that EMDR was the best tool to use. He will be on vacation next week and said he only had one appt open before the new year, but that he does work with both the ins co's involved. He also knows the therapist who has been seeing me and suggested I keep the appt with her in 2 days and discuss with her either having a consult with him (recommended by her) or just starting fresh with the new company if I still want to see him.

I did not call the secretary from the other office since I was unsure at that point what to do after talking to the above person. It seems like a lot of people are taking next week off so I may not have the option to see someone through the present co.

I don'tknow why this is so hard for me. What do you think of the above comment? Do you agree? Since I couldn't get an appt this week anyway I will keep the Sat appt. But am a little confused with the choices. Should I just insist on EMDR and find someone who agrees on the phone, or does the person at the beginning of this message make sense? Both places at cog-beh groups that are local. I guess I am also in the clutches of the nameless dread. Haven't yet heard from any of the other 5 people.


> Call back both the one who left a message and the secretary for the therapists he referred you to. Ask first if they even have an appointment available before Jan 1. If not, then move on to questions about insurance and what they recommend to facilitate getting a session or two paid for in the new year. If one of them does have an opening, that makes it easier; take it. It'll be OK. don't worry about whether your problem is "worthy;" I promise it is. Don't worry whether you can come up with a "trauma" or not; I once did a session with a man who had what he called "the nameless dread," just a feeling, no trauma that he could remember. He didn't really meet criteria for a "disorder" and he'd been to lots of therapists and doctors and no meds helped. He got referred to me as a last resort, he wasn't very hopeful and thought I was probably a sham artist. We did the procedure anyway and much to his surprise the dread went away. He never did recover any sort of traumatic memory or anything, although he did work through some problems that had been caused by the feeling. I saw his family doctor several months ago and he told me the man was doing well, no meds, working and engaged (hadn't worked or dated in about 7 years). So no problem is too vague or simple to work on. And let me reiterate: I myself was not the miracle worker here; in fact I didn't say more than a dozen words in the whole two hours; the healing came from within the patient and it persists.

 

Re: EMDR?????

Posted by Toby on December 18, 1998, at 8:50:52

In reply to Re: EMDR?????, posted by DL on December 17, 1998, at 23:16:28

Yes, he does make sense. An interview is part of the protocol and helps establish what will be worked on, usually a specific relxation technique is given to prepare the person and also to provide an "escape" if the memory gets too stressful during the session, and also the therapist can answer questions and make sure the person knows what to expect during the session and possible results. Sometimes I break the rule of having a preliminary interview if the person is referred to me by someone I can trust to have done a good interview, prepared the person beforehand and I have their history before the session. Then I can just go straight into it. But every therapist is different and his recommendation is reasonable; especially since he does work with the insurance company you will have in January and knows how they handle things.

 

Re: EMDR?????

Posted by DL on December 18, 1998, at 14:21:18

In reply to Re: EMDR?????, posted by Toby on December 18, 1998, at 8:50:52

> Yes, he does make sense. An interview is part of the protocol and helps establish what will be worked on

This person gave me the feeling that he felt EMDR might not be the choice of tx after the interview--only one possibility. He said that EMDR is effective but not as much a panacea as previously thought. It is only one of many techniques used in his cog/beh practice. I understand the need for an interview. But I don't think he meant an interview for EMDR--but rather an interview to decide which technique should be used.

, usually a specific relxation technique is given to prepare the person and also to provide an "escape" if the memory gets too stressful during the session

What types of relaxation tech's? These are hard for me.

Had one more call from a social worker who uses EMDR. She will be on vaction till mid Jan and said she has a pretty full schedule but I could call after mid Jan to ask any questions.

CAn you give me a comment on the first paragraph? I think what he's telling me is not to search for EMDR tx, but to find a therapist who can help me move in the direction I want--and if they feel EMDR is the way to go, then they will provide it--if not they will use something else. Is this good or should I find someone willing to provide EMDR anyway?

 

Re: EMDR?????

Posted by Elizabeth on December 20, 1998, at 2:00:36

In reply to Re: EMDR?????, posted by DL on December 18, 1998, at 14:21:18

OK, what I have heard (from several pretty reasonable CBT types, also noted the existence of at least a few studies on the subject) about EMDR is that it is no more effective with the eye movements (the only novel part of the tx) than it is without them. That is, it doesn't add anything new to existing treatments for phobias, PTSD, etc. (exposure therapies).

There's also no particular theoretical basis for it...it seems really faddish to me, overall. :-(

 

Re: EMDR?????

Posted by Toby on December 28, 1998, at 10:04:11

In reply to Re: EMDR?????, posted by DL on December 18, 1998, at 14:21:18

Would have answered sooner, but couldn't get the computer to post for me; my server was always busy, probably because of the holidays.

It's hard to tell what he's thinking; maybe just covering his bases, doesn't want to guarantee EMDR if you get to his office and he feels it isn't right for you. It indeed is not a panacea (that is a reason why I was skeptical of it initially myself; people were overrating it), but you would be using it for very specific traumas: your father's bizarre and frightening behaviors toward you and your brother, your husband's abuse of you, and the like. If you and the therapist approach it like that, I think it will be helpful to you. Perhaps the therapist also doesn't want you to get the idea that it will cure depression that is genetically or chemically induced, but you already know this and can assure him you aren't looking for a magic bullet, just something to scoop out the pieces of junk others have burdened you with. We already know you are a strong person who can and will take care of yourself and move ahead with your life; these few bad apples just need to get tossed out so they can stop ruining the rest of your crop. (Pardon all the metaphors)

If your insurance will allow this initial visit (I guess he's not going to see you at no charge the first time) it may well be worth while to see what advice he has about EMDR for those things listed above. If you are still going to be seeing your old therapist, you don't need another one unless it is specifically for EMDR. If you are having to stop with your other therapist, then having one who can incorporate EMDR plus his other techniques is a good option.

 

Healing

Posted by DL on December 29, 1998, at 22:18:00

In reply to Re: EMDR?????, posted by Toby on December 28, 1998, at 10:04:11

> Would have answered sooner, but couldn't get the computer to post for me; my server was always busy, probably because of the holidays.

I also had trouble with the site. I assumed you would be away for the holidays but was surprised at how disappointed I was yesterday when I couldn't get through to the site...You have offered me something that has been missing in my life and I cherish it in the same way I do the sleep I now enjoy. When someone comes near to the empty and anguished part of me (that I hide well) I so much want to connect but at the same time I feel guilty? unworthy? afraid?--like magnets pulling to opposites. ...Like the little girl I was once--wandering lost in a giant woods. When a hand finally does reach out she is afraid to take it. I feel that you have offered a hand to guide me through some of the rough spots.--And that there is someone who respects the silent fighter in me--someone who is totally non-judgemental and always comes back for me....Thank you.....

In my work the pain from my past has sometimes become an asset. When a mom tells me she has not slept well for days and doesn't know what to do, I REALLY DO UNDERSTAND. When a child is fearful all the time, I understand how it feels inside, and I accept that no explanations are needed. I know how it feels to have to be protected by steel walls for defense. And I sense the unwritten and unsaid in a home.

> It's hard to tell what he's thinking; maybe just covering his bases, doesn't want to guarantee EMDR if you get to his office and he feels it isn't right for you....., but you would be using it for very specific traumas:

Since Jan 1 is ina few days and everyone is on vacation I will need to call the new insurance co and figure out the process to go through to have mental health visits covered. Then I will probably switch to someone new if they will cover it. I have an appt with the MD on Jan 7 for a medication check. Hopefully the new co. will cover it. They may want me to switch from the Remeron to something else since they don't "prefer" it. But I am absolutely terrified that if the sleep problems come back they will never go away. Also my anxiety level has been drastically reduced.

> We already know you are a strong person

Thank you.........Thank you. Why does this bring tears to my eyes? I do not cry in the car anymore but there are still times when I just feel empty, buried, lost, and rain silent tears. However these times are much less often.

> these few bad apples just need to get tossed out

Yes, I guess I want to look at the bad apples but I just need someone to give me a push and then be there to hold my hand.

QUESTION; The appetite and weight gain thing is terrible. I feel hungry all the time even when I'm full--I have not had to deal with this before. I now empathize with people who have had weight problems! I hate myself for gaining but can't seem to stop it. Will increasing the Remeron help? Should I dare to try combining another AD (after my previous experiences?) Here I am in the same place again--I am afraid to stop the Remeron but also afraid of what it is doing to me!

COMMENT: On Christmas Eve I went to a Unitarian-Universalist Chruch alone. I haven't been to church in many years. It's a chruch that accepts teachings from all different religions and most parts of the service were done by children and family members. It was a beautiful church. I was drawn to go and be part of it, but that old feeling of being sad and tearful came back. It's a sort of inner ache. I don't know why it's there.

 

Re: Appetite

Posted by Toby on December 30, 1998, at 8:59:23

In reply to Healing, posted by DL on December 29, 1998, at 22:18:00

With Remeron, the more norepinephrine, the less effect from histamine. Histamine is what causes the appetite to increase. Theorectically, increasing the dose another 15 mg should help here. In lieu of that, people have recently been telling me that the sports drinks, Gatorade and whatnot, are very useful for keeping the stomach full, but that unlike plain water, there are enough calories to decrease actual hunger but not too many calories like soda has. They also have no caffeine and are better for you than diet soda. Bananas, apples, and oranges are good to snack on, as is Chex mix, and raw veggies (tomatoes being better for some people than carrots in terms of satisfying hunger). Don't forget exercise, either. If you can't afford a membership at a health club or the YMCA, libraries often have exercise videos to check out for free (which is good because you can vary your routine more than if you had to buy only a few and then get bored). Exercise moves the blood supply away from the stomach so that hunger decreases immediately afterwards. And, now that the New Year is coming, maybe a lot of these high calorie snacks will disappear from the office for awhile. Take care.

 

Re: Appetite

Posted by DL on December 30, 1998, at 12:22:21

In reply to Re: Appetite, posted by Toby on December 30, 1998, at 8:59:23

> With Remeron, the more norepinephrine, the less effect from histamine. Histamine is what causes the appetite to increase.

Why does Remeron help my sleep and anxiety if it increases norepinephrine when the Pamelor I took 1 1/2 yrs ago (which inc norepinephrine also) did not? All I remember was orthostatic hypotension, terrible dry mouth and eventually tremor. If I increase the Remeron will I lose some of the sleep and anxiety effects?

Theorectically, increasing the dose another 15 mg should help here.

I will call and check with the MD or perhaps wait till the Jan 7 appt. and ask then. If you search this site under REmeron you will find some newer responses about mixing Remeron and SSRI's with good results. Would this be a possibility for me or since I finally have some good results should I stay with only Remeron? I guess it is nice to finally get my head above the dark waters and I can see other people laughing and living on land in the sun?

> In lieu of that, people have recently been telling me that the sports drinks, Gatorade and whatnot, are very useful for keeping the stomach full, but that unlike plain water, there are enough calories to decrease actual hunger but not too many calories like soda has. They also have no caffeine and are better for you than diet soda.

The only soda I drink is occasional glass of caffeine free diet coke. Caffeine is still not a friend-- Have you read the comments in the other part of this site about predicting who will react with aggitation to Prozac and SSRI's by asking if they drink coffee or caffeinated beverages? The MD's said people who become uncomfortably activated on caffeinated drinks usually avoid them and this is a good predictor of the above reaction to SSRI's. Any comment? Do you find this true?
I will try the sports drink idea--keep it in the car when I go from home to home.

>Bananas, apples, and oranges are good to snack on, as is Chex mix, and raw veggies (tomatoes being better for some people than carrots in terms of satisfying hunger).

I have lots of apples and bags of those tiny carrots with me usually. I have found that the new dried cranberries are good to snack. I realize they are concentrated calories, but they are good because they are tart and need to be chewed one at a time.

Don't forget exercise, either. If you can't afford a membership at a health club or the YMCA, libraries often have exercise videos to check out for free (which is good because you can vary your routine more than if you had to buy only a few and then get bored). Exercise moves the blood supply away from the stomach so that hunger decreases immediately afterwards.

With the change in health ins I think I get a cut rate at some health clubs. I will check to see how expensive. The exercise class I have gone to 3xwk for 6 or 7 years is a half hour drive from my new place and with workand the changes I haven't been in a while. I can keep exer clothes in the car and try to get there too. I used to walk a lot and that is more diff now (We have snow and some ice). But I used to walk early Sun morn and can try that too.

> And, now that the New Year is coming, maybe a lot of these high calorie snacks will disappear from the office for awhile.

You're right! All sorts of things showed up there. And it was terrible for me since sweets were never my thing. I couldn't believe that I was attracted to them!

> Take care.

Yes.....Thank you.......this part is as healing to me as anything else....

 

Re: Appetite

Posted by Toby on December 31, 1998, at 8:56:18

In reply to Re: Appetite, posted by DL on December 30, 1998, at 12:22:21

One can never predict or reason out why one medication does badly and another one does well even when they are supposed to do similar things. For example, some kids respond to ritalin for ADD and some respond to dexedrine, but swap one for the other and they may do just dreadfully. Theorectically, both are just stimulants and should have the same effects and same side effects, but it just doesn't work that way. In the Bible it says,"we are wonderfully made," which I have seen to be modernly translated as "mysteriously." In this business I see it is true.

I have seen that it is true also about the caffeine phenomenon you mentioned. It can be a good predictor, though not always absolutely. I mostly use it for a predictor of who to start their SSRI dose (if there is a compelling reason to use one over another kind of antidepressant) at a very tiny tiny dose rather than the standard starting dose.

I have generally not seen a change in sleep when increasing the dose of Remeron, especially in a patient who has been on it as long as you have. The reason may be that the sleep has finally responded in conjunction with the relief from depression (since insomnia is a symptom of depression), instead of being a separate entity that needed treatment. Raising the dose then, would be mainly for reducing side effects; but, too, if you are thinking you need more anitdepressant effect since you mentioned adding an SSRI, perhaps the dose needs to be raised to get more antidepressant effect from the Remeron itself.

Have a Happy New Year. Will talk at you again on Monday on a new post since these will be gone.


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