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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by cherylann on October 25, 2004, at 22:29:46
At least according to my family. It's really too bad cuz I had a delicate balance of remeron, klonopin, and fish oil that was working great.
Now I'm having heart palpitations, painful walking after sitting for a while (which I suspect is from the 30lbs I've gained), HORRIBLE mood swings and severe depression, especially in the mornings.
After some intensive research, I'm going to ask the doc to let me try cymbalta and because I can't sleep at night, a low dose of seroquel. The reason why I choose this is because I respond so well to tricyclics, but cymbalta only helps with serotonin and norepinephrine. I've read that seroquel helps with dopamine, which is the other chemical tricyclics trigger.
For anyone out there with more working brain cells than me, does this sound logical? My family is about ready to disown me and I'm desperate.
Thanks,
cherylann
Posted by jboud24 on October 25, 2004, at 22:51:41
In reply to Remeron has stopped working and I am a monster, posted by cherylann on October 25, 2004, at 22:29:46
Yes it sounds like you're on the right track. At least you have a plan. I think the move to Cymbalta would work great since it target increased 5-HT and NE just like Remeron. Seroquel sounds like a good option for insomnia or balance as well. It is the AP with the least side-effects, and it seems to be much less, shall we say 'weight-friendly', then does Remeron.
I def. think you're on the right track. Hang in there.
Justin
Posted by King Vultan on October 25, 2004, at 22:51:50
In reply to Remeron has stopped working and I am a monster, posted by cherylann on October 25, 2004, at 22:29:46
> At least according to my family. It's really too bad cuz I had a delicate balance of remeron, klonopin, and fish oil that was working great.
> Now I'm having heart palpitations, painful walking after sitting for a while (which I suspect is from the 30lbs I've gained), HORRIBLE mood swings and severe depression, especially in the mornings.
> After some intensive research, I'm going to ask the doc to let me try cymbalta and because I can't sleep at night, a low dose of seroquel. The reason why I choose this is because I respond so well to tricyclics, but cymbalta only helps with serotonin and norepinephrine. I've read that seroquel helps with dopamine, which is the other chemical tricyclics trigger.
> For anyone out there with more working brain cells than me, does this sound logical? My family is about ready to disown me and I'm desperate.
> Thanks,
> cherylann
Seroquel is an atypical antipsychotic which has differing effects on dopamine. Basically, it is designed to boost dopamine in certain dopamine pathways to counteract the negative effects of blockading dopamine D2 receptors, the latter effect being common to all antipsychotic drugs. In the older, conventional antipsychotics, there were a great many negatives associated with the D2 receptor blockade, such as movement disorders and the dreaded tardive dyskinesia. Atypical antipsychotics such as seroquel are much better this way, but weight gain can unfortunately still be a big problem.Tricyclics mostly just work on serotonin and norephinephrine, as Cymbalta does. Some of them, such as nortriptyline, can indirectly boost dopamine because they utilize the same mechanism atypical antipsychotics use to do this (blockade of serotonin 2A receptors).
Todd
Posted by Sad Panda on October 26, 2004, at 9:44:17
In reply to Remeron has stopped working and I am a monster, posted by cherylann on October 25, 2004, at 22:29:46
> At least according to my family. It's really too bad cuz I had a delicate balance of remeron, klonopin, and fish oil that was working great.
> Now I'm having heart palpitations, painful walking after sitting for a while (which I suspect is from the 30lbs I've gained), HORRIBLE mood swings and severe depression, especially in the mornings.
> After some intensive research, I'm going to ask the doc to let me try cymbalta and because I can't sleep at night, a low dose of seroquel. The reason why I choose this is because I respond so well to tricyclics, but cymbalta only helps with serotonin and norepinephrine. I've read that seroquel helps with dopamine, which is the other chemical tricyclics trigger.
> For anyone out there with more working brain cells than me, does this sound logical? My family is about ready to disown me and I'm desperate.
> Thanks,
> cherylann
>Hi Cherylann,
How much Remeron are you taking? If you can't get sleep with Remeron, then Seroquel isn't going to be much use either. If you had success with TCA's, why not go back to them?
Cheers,
Paul.
Posted by cherylann on October 26, 2004, at 12:13:55
In reply to Re: Remeron has stopped working and I am a monster » cherylann, posted by Sad Panda on October 26, 2004, at 9:44:17
I am currently on 30mgs of remeron. It's not the sleep that's the problem right now. I'm sleeping pretty good with an addition of .5mgs of klonopin.
It's the depression and, as of this morning, the panic is back. None of my usual tricks are working, like directed thinking etc.
The reason I don't want to try another TCA is because of weight gain. I don't mind the 30lbs I've gained on remeron, but I know from experience that starting another TCA will make me gain more weight on top of the 30lbs. That will cause more health issues. At least if I give the cymbalta a try, I'll hopefully lose some of this weight, and if it doesn't work I'll move on to another TCA.
Thanks,
cherylann
Posted by jboud24 on October 26, 2004, at 12:56:02
In reply to Re: Remeron has stopped working and I am a monster » cherylann, posted by Sad Panda on October 26, 2004, at 9:44:17
> Hi Cherylann,
>
> How much Remeron are you taking? If you can't get sleep with Remeron, then Seroquel isn't going to be much use either. If you had success with TCA's, why not go back to them?
>
> Cheers,
> Paul.Gee, I didn't know Remeron has a dopamie blockading effect like Seroquel. That's a new one on me. I do know, however, that when I was taking Remeron (and still am) 30mgs, that if I skipped out on the Remeron and took Seroquel it had a noticably different sedating action to it. I wouldn't say more sedating, just different sedating. It really might be worth a shot.
Justin
Posted by King Vultan on October 26, 2004, at 14:19:48
In reply to Seroquel/Remeron » Sad Panda, posted by jboud24 on October 26, 2004, at 12:56:02
>
> > Hi Cherylann,
> >
> > How much Remeron are you taking? If you can't get sleep with Remeron, then Seroquel isn't going to be much use either. If you had success with TCA's, why not go back to them?
> >
> > Cheers,
> > Paul.
>
> Gee, I didn't know Remeron has a dopamie blockading effect like Seroquel. That's a new one on me. I do know, however, that when I was taking Remeron (and still am) 30mgs, that if I skipped out on the Remeron and took Seroquel it had a noticably different sedating action to it. I wouldn't say more sedating, just different sedating. It really might be worth a shot.
>
> Justin
>
>What Panda is talking about doesn't really have anything to do with dopamine, at least not directly, and Remeron does not blockade dopamine D2 receptors to any noteworthy extent. The sedative properties of Remeron are related to its powerful histamine H1 blockade combined with its blockade of serotonin 2A receptors. These two blockades are also largely responsible for the notorious weight gain problems associated with Remeron, the histamine blockade probably being the worse of the two that way. He appears to feel Seroquel is unlikely to be as sedating as Remeron is, which sounds like a reasonable assumption, but I haven't tried either of these drugs and really don't know firsthand how sedating either is. I do think a low dose of Seroquel is probably not as likely to induce weight gain as 30 mg of Remeron, so it may be worth a try, anyway.
Todd
Posted by jboud24 on October 26, 2004, at 15:56:46
In reply to Re: Seroquel/Remeron » jboud24, posted by King Vultan on October 26, 2004, at 14:19:48
So serotonin 2a blockade is involved in increased appetite? I thought that it was the 5-HT3 blockade (ala granisetron) that by inversely getting rid of nausea was a pro-hunger mechanism. I know that the histaminergic action has also been implicated in the pro-hunger effects, but I didn't know the 2a receptor was. It would be interesting to know whether or not a drug with a more pure 2a antagonism would cause increased hunger.
I also thought that dopaminergic blockade caused some level of sedation or somnolence. Am I wrong about that? I'm just saying maybe giving Seroquel a shot could work for decreasing the hunger thing while still providing some relief from insomnia. I've only taken Seroquel once, but it was definitely sedative in a way not akin to what I had been used to with Remeron. If only Remeron came without that 5-HT3 receptor blockade I'd like it so much more.
Justin
Posted by Sad Panda on October 26, 2004, at 22:39:38
In reply to Seroquel/Remeron » Sad Panda, posted by jboud24 on October 26, 2004, at 12:56:02
> Gee, I didn't know Remeron has a dopamie blockading effect like Seroquel. That's a new one on me.
>
>Gee, I don't recollect saying that Remeron has a dopamie blockading effect like Seroquel.
At low doseages Seroquel is just an expensive antihistamine & has no effects on dopamine receptors.
Posted by Sad Panda on October 26, 2004, at 22:51:10
In reply to Re: Seroquel/Remeron » King Vultan, posted by jboud24 on October 26, 2004, at 15:56:46
> So serotonin 2a blockade is involved in increased appetite? I thought that it was the 5-HT3 blockade (ala granisetron) that by inversely getting rid of nausea was a pro-hunger mechanism. I know that the histaminergic action has also been implicated in the pro-hunger effects, but I didn't know the 2a receptor was. It would be interesting to know whether or not a drug with a more pure 2a antagonism would cause increased hunger.
>
> I also thought that dopaminergic blockade caused some level of sedation or somnolence. Am I wrong about that? I'm just saying maybe giving Seroquel a shot could work for decreasing the hunger thing while still providing some relief from insomnia. I've only taken Seroquel once, but it was definitely sedative in a way not akin to what I had been used to with Remeron. If only Remeron came without that 5-HT3 receptor blockade I'd like it so much more.
>
> Justin
>It's more likely to be serotonin 2C receptor blockade that causes an increase in appetite, unfortunately most things that block 2A also block 2C receptors & to some degree type 3 receptors.
Cheers,
Paul.
Posted by King Vultan on October 26, 2004, at 23:17:02
In reply to Re: Seroquel/Remeron, posted by Sad Panda on October 26, 2004, at 22:51:10
> >
>
> It's more likely to be serotonin 2C receptor blockade that causes an increase in appetite, unfortunately most things that block 2A also block 2C receptors & to some degree type 3 receptors.
>
> Cheers,
> Paul.
Right, sorry to be so sloppy, tried trazodone again as a sleep aid two nights ago and am still trying to recover from the lack of sleep. The 2C receptor does seem to be the one most involved with appetite, but unfortunately, this gets blocked by many drugs that also blockade 2A. When I see a 2A blockade, I automatically tend to think to myself "increased appetite," but this isn't necessarily true. I'm reading a paper right now on risperidone that claims it is selective for 2A over 2C at very low dosages. Perhaps there might be something to this.Todd
Posted by jboud24 on October 27, 2004, at 1:00:07
In reply to Re: Seroquel/Remeron, posted by King Vultan on October 26, 2004, at 23:17:02
Okay thanks. I didn't realize that the 2c receptor was indeed involved in hunger. I just assumed 5-HT3 dealt with hunger since that is what the serotonin-based anti-nauseant drugs target. Indeed, if this is so, then Remeron really is like the ultimate pro-appetite medications.
Justin
Posted by Sad Panda on October 27, 2004, at 4:57:35
In reply to Re: Seroquel/Remeron, posted by King Vultan on October 26, 2004, at 23:17:02
>
> > >
> >
> > It's more likely to be serotonin 2C receptor blockade that causes an increase in appetite, unfortunately most things that block 2A also block 2C receptors & to some degree type 3 receptors.
> >
> > Cheers,
> > Paul.
>
>
> Right, sorry to be so sloppy, tried trazodone again as a sleep aid two nights ago and am still trying to recover from the lack of sleep. The 2C receptor does seem to be the one most involved with appetite, but unfortunately, this gets blocked by many drugs that also blockade 2A. When I see a 2A blockade, I automatically tend to think to myself "increased appetite," but this isn't necessarily true. I'm reading a paper right now on risperidone that claims it is selective for 2A over 2C at very low dosages. Perhaps there might be something to this.
>
> Todd
>
>Seems like a lot of people have poor reactions to Trazodone, do you get that reaction immediately or do you have to wait for m-CPP to form?
During my time on Remeron I didn't have any increase in appetite or weight gain but since swapping to Amitriptyline I have had a few carb cravings. :/
Posted by King Vultan on October 27, 2004, at 9:51:54
In reply to Re: Seroquel/Remeron » King Vultan, posted by Sad Panda on October 27, 2004, at 4:57:35
> >
>
> >
>
> Seems like a lot of people have poor reactions to Trazodone, do you get that reaction immediately or do you have to wait for m-CPP to form?
>
> During my time on Remeron I didn't have any increase in appetite or weight gain but since swapping to Amitriptyline I have had a few carb cravings. :/
>It was bad right from the get-go. It's only every other night I have trouble sleeping because I use Halcion/triazolam the other nights. I guess I will have to talk to my pdoc about a prescription antihistamine or tricyclic to replace the Benadryl I typically use to fill in, which really isn't even close to adequate for this Parnate induced insomnia. I think he'd be more willing to prescribe an antihistamine than a tricyclic because I'm on an MAOI, and he had mentioned hydroxyzine at an earlier appointment.
Todd
Posted by LyndaK on October 28, 2004, at 0:13:46
In reply to Re: Remeron has stopped working and I am a monster » Sad Panda, posted by cherylann on October 26, 2004, at 12:13:55
Did you try increasing your dose of Remeron? I take 60mgs. per day and have finally stabilized at that dose, get good sleep, good control of anxiety. Just one step down from that (45 mgs.) starts to bring back the insomnia and anxiety. I gained 20 pounds with Remeron but increasing the dose did NOT make me gain any more. It might be worth a try just upping the Remeron instead of switching to a different drug.
Lynda
> I am currently on 30mgs of remeron. It's not the sleep that's the problem right now. I'm sleeping pretty good with an addition of .5mgs of klonopin.
> It's the depression and, as of this morning, the panic is back. None of my usual tricks are working, like directed thinking etc.
> The reason I don't want to try another TCA is because of weight gain. I don't mind the 30lbs I've gained on remeron, but I know from experience that starting another TCA will make me gain more weight on top of the 30lbs. That will cause more health issues. At least if I give the cymbalta a try, I'll hopefully lose some of this weight, and if it doesn't work I'll move on to another TCA.
> Thanks,
> cherylann
Posted by jujube on October 28, 2004, at 11:03:05
In reply to Re: Remeron has stopped working and I am a monster » cherylann, posted by LyndaK on October 28, 2004, at 0:13:46
Lynda,
Did you find Remeron effective for depression as well as anxiety? I am currently looking for a new AD, having not had any success with Paxil (worked great the first time), Prozac, Effexor XR and now Celexa. The weight gain associated with Remeron worries me (I'm only 5'5" and 135 lbs, so I'm big enough as it is and can't really afford to gain any more weight). Anything you can tell me would be greatly appreciated. Thanks.
Tamara
> Did you try increasing your dose of Remeron? I take 60mgs. per day and have finally stabilized at that dose, get good sleep, good control of anxiety. Just one step down from that (45 mgs.) starts to bring back the insomnia and anxiety. I gained 20 pounds with Remeron but increasing the dose did NOT make me gain any more. It might be worth a try just upping the Remeron instead of switching to a different drug.
>
> Lynda
>
> > I am currently on 30mgs of remeron. It's not the sleep that's the problem right now. I'm sleeping pretty good with an addition of .5mgs of klonopin.
> > It's the depression and, as of this morning, the panic is back. None of my usual tricks are working, like directed thinking etc.
> > The reason I don't want to try another TCA is because of weight gain. I don't mind the 30lbs I've gained on remeron, but I know from experience that starting another TCA will make me gain more weight on top of the 30lbs. That will cause more health issues. At least if I give the cymbalta a try, I'll hopefully lose some of this weight, and if it doesn't work I'll move on to another TCA.
> > Thanks,
> > cherylann
>
Posted by LyndaK on October 29, 2004, at 2:24:07
In reply to Re: Remeron has stopped working and I am a monster » LyndaK, posted by jujube on October 28, 2004, at 11:03:05
Jujube,
Yes, it has been effective for both depression and anxiety -- for me. It may or may not for you, that's why we've all been on a long list of different drugs before finding one that works best (I too tried all the ones on your list.)
Most people gain weight on Remeron. How much weight depends on the individual. I gained 20 pounds, pretty much all in the beginnng, and haven't continued to gain. I don't like the extra weight, but it's better than being depressed. It also caused a lot of sleepiness and dizziness at first -- those side-effects decreased with time, but it can really wipe you out for the first few days.
Hope this helps. Good luck with your search.
Lynda
Posted by jujube on October 29, 2004, at 8:56:43
In reply to Re: Remeron has stopped working and I am a monster » jujube, posted by LyndaK on October 29, 2004, at 2:24:07
Thanks. I'll put Remeron on my list to discuss with the pdoc. I know the weight gain can be a problem. A friend of mine who has suffered from depression pretty much all of her life was on Remeron and she gained a ton of weight. I guess everybody is different. I've heard a lot of people gain a lot of weight on Paxil. When I was on it, I gained a little, but it was good because I hadn't really been eating for months and months before I went on it. So, I needed to put on a few. I guess a little bit of weight gain is better than being depressed.
Take care.
Tamara
> Jujube,
>
> Yes, it has been effective for both depression and anxiety -- for me. It may or may not for you, that's why we've all been on a long list of different drugs before finding one that works best (I too tried all the ones on your list.)
>
> Most people gain weight on Remeron. How much weight depends on the individual. I gained 20 pounds, pretty much all in the beginnng, and haven't continued to gain. I don't like the extra weight, but it's better than being depressed. It also caused a lot of sleepiness and dizziness at first -- those side-effects decreased with time, but it can really wipe you out for the first few days.
>
> Hope this helps. Good luck with your search.
> Lynda
This is the end of the thread.
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