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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by cole on September 6, 2001, at 15:58:19
CAM-- thought I'd see what you had to say about the mix of meds and the dosage level with the Rem-- have you seen anything higher?
OK guys, here's the story. I'm currently at 90mg Remeron/ night. I also take 20 mg Methylphenidate SR for focus/ fatigue relief PRN and ~25 mg Trazodone for sedation after a day on the Methylph.
This is the pattern: after a stressful period (finals, MCAT, moving)which are very common this year as a post-bacc premed student, my fibromyalgia flares. This in turn causes my depression to break through my meds, and then results in a need for increased dosing to achieve prior AD response. My doc and I decided that 90 was about as high as we should take the Rem, unless anyone here has experience to the contrary. I personally haven't ever seen anything suggesting doses above this level are safe or recommended.
I've been handed a script for Buspar, my doc says she has read that it can augment the SSRIs and TCAs so she believes it will similarly augment the Rem. Any have any experience/ ideas about this combo? The movement disordering mentioned above was a bit frightening to me. I'll be starting really low-- ~2.5mg bid, then gradually titrating up to 15 bid.
Her other idea was augmentation with a beta blocker, but I felt that wasn't a good idea with my hx of fairly low BP and the implication of neurally mediated hypotension in CFS/ FMS.
Anyone with ideas or links on this will be helpful.
Thanks,
Cole
Posted by Cam W. on September 6, 2001, at 17:07:34
In reply to Remeron augment/ Buspar (CAM???), posted by cole on September 6, 2001, at 15:58:19
Cole - I may not be the best person to ask about Remeron™ (mirtazapine) augmentation, as I have no personal experience with the drug (not available in Canada).
There should be no problem adding BuSpar™ (buspirone) to Remeron. I don't think that there are any clinically significant interactions between the two. The Remeron dose seems rather high, but this may only be because I have not read of anyone taking the dose that high.
I have never seen anyone experience movement disorders using BuSpar with an SSRI, although I have read of instances where it has happened. Low and slow is probably the way to go with the BuSpar.
Since your family has a history of low blood pressure, I would probably stick with the BuSpar and give it a good trial (eg. 8 weeks) before giving up on it. A low dose of a beta blocker, like Inderal™ (propranolol 10mg bid or tid) may work, without lowering your blood pressure too much. You would have to have your blood pressure monitored closely if you were to take this approach.
Sorry that I cannot be of more help. - Cam
Posted by Simcha on September 7, 2001, at 8:04:47
In reply to Remeron augment/ Buspar (CAM???), posted by cole on September 6, 2001, at 15:58:19
This is the combo my brother is on. It seems to work well for him. He had a hard time finding the right combo for him and they finally settled on this combo for now. I hope you find your combo soon.
> CAM-- thought I'd see what you had to say about the mix of meds and the dosage level with the Rem-- have you seen anything higher?
>
> OK guys, here's the story. I'm currently at 90mg Remeron/ night. I also take 20 mg Methylphenidate SR for focus/ fatigue relief PRN and ~25 mg Trazodone for sedation after a day on the Methylph.
>
> This is the pattern: after a stressful period (finals, MCAT, moving)which are very common this year as a post-bacc premed student, my fibromyalgia flares. This in turn causes my depression to break through my meds, and then results in a need for increased dosing to achieve prior AD response. My doc and I decided that 90 was about as high as we should take the Rem, unless anyone here has experience to the contrary. I personally haven't ever seen anything suggesting doses above this level are safe or recommended.
>
> I've been handed a script for Buspar, my doc says she has read that it can augment the SSRIs and TCAs so she believes it will similarly augment the Rem. Any have any experience/ ideas about this combo? The movement disordering mentioned above was a bit frightening to me. I'll be starting really low-- ~2.5mg bid, then gradually titrating up to 15 bid.
>
> Her other idea was augmentation with a beta blocker, but I felt that wasn't a good idea with my hx of fairly low BP and the implication of neurally mediated hypotension in CFS/ FMS.
>
> Anyone with ideas or links on this will be helpful.
>
> Thanks,
> Cole
Posted by cole on September 7, 2001, at 20:19:32
In reply to Re: Remeron augment/ Buspar (CAM???) » cole, posted by Simcha on September 7, 2001, at 8:04:47
Cam and Simcha,
Thanks for your responses. I took 2.5 mg this afternoon just to feel it out, and I don't really notice anything substantial. Though, I might feel a bit perkier-- kinda odd since this med is supposed to be sedating for most. We'll have to see. I do hope this is the combo for me, it was a struggle just to find the Remeron, I don't feel like starting from square one again. I'll try to post back if this does the trick-- my experiences might help others.
cole
This is the end of the thread.
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