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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by ed_uk on August 19, 2005, at 9:17:22
Psychomotor restlessness
The use of mirtazapine has been associated with the development of psychomotor restlessness, which clinically may be very similar to akathisia, characterised by a subjectively unpleasant or distressing restlessness and need to move often accompanied by an inability to sit or stand still. This is most likely to occur within the first few weeks of treatment. In patients who develop these symptoms, increasing the dose may be detrimental and it may be necessary to review the use of mirtazapine.
Withdrawal symptoms seen on discontinuation of mirtazapine treatment
Withdrawal symptoms when treatment is discontinued are common, particularly if discontinuation is abrupt. In clinical trials adverse events seen on treatment discontinuation occurred in approximately 15% of patients treated with mirtazapine. The risk of withdrawal symptoms may be dependent on several factors including the duration and dose of therapy and the rate of dose reduction.
Dizziness, agitation, anxiety, headache and nausea and/or vomiting are the most commonly reported reactions. Generally these symptoms are mild to moderate, however, in some patients they may be severe in intensity. They usually occur within the first few days of discontinuing treatment, but there have been very rare reports of such symptoms in patients who have inadvertently missed a dose. Generally these symptoms are self-limiting and usually resolve within 2 weeks, though in some individuals they may be prolonged (2-3 months or more). It is therefore advised that mirtazapine should be gradually tapered when discontinuing treatment over a period of several weeks, according to the patient's needs.
~Ed
Posted by linkadge on August 19, 2005, at 15:27:11
In reply to New warnings added to Remeron in the UK, posted by ed_uk on August 19, 2005, at 9:17:22
I wonder what the mechanism for the akathesia is.
Linkadge
Posted by ed_uk on August 19, 2005, at 15:41:11
In reply to Re: New warnings added to Remeron in the UK, posted by linkadge on August 19, 2005, at 15:27:11
>I wonder what the mechanism for the akathesia is.
I believe it's the alpha-2 antagonism. Clonidine, an alpha-2 agonist, appears to be an effective treatment for akathisia.
Akathisia-like symptoms seem to occur mainly at high doses of Remeron.
~ed
Posted by Phillipa on August 19, 2005, at 18:23:23
In reply to Re: New warnings added to Remeron in the UK » linkadge, posted by ed_uk on August 19, 2005, at 15:41:11
When I took l5mg of remeron for sleep it didn't do a thing when i took it or stopped it. Fondly, Phillipa
Posted by crazychickuk on August 19, 2005, at 18:25:49
In reply to Re: New warnings added to Remeron in the UK » ed_uk, posted by Phillipa on August 19, 2005, at 18:23:23
More than that
i stopped it a yr ago and am stil suffering.. sure it did something to my dopamine i am so paranoid
(2 yrs of taking 30mg, stopped suddenly as they changed the tab form)
Posted by rod on August 19, 2005, at 18:56:52
In reply to New warnings added to Remeron in the UK, posted by ed_uk on August 19, 2005, at 9:17:22
Hi!
When I tried Remeron it gave me a severe mask like face accompanied with an urge to move my feet... Seems to be some antidopamingeric crap to me! I am really angry at this drug.... and made my depression severly worse!
bye
crazybornaguy_at :P
Posted by SandyWeb on August 19, 2005, at 19:03:56
In reply to Re: New warnings added to Remeron in the UK, posted by rod on August 19, 2005, at 18:56:52
I've been taking 45 mg for almost one year now. Absolutely no problems with it, and it has done wonders for me!
God bless!
Sandy
Posted by linkadge on August 19, 2005, at 20:42:48
In reply to Re: New warnings added to Remeron in the UK, posted by SandyWeb on August 19, 2005, at 19:03:56
Perhaps the serotonin release that is conferred by the alpha-2 antagonism demonstrates and intrinsic antidopaminergic effect.
Linkadge
Posted by 4WD on August 19, 2005, at 21:57:05
In reply to Re: New warnings added to Remeron in the UK » linkadge, posted by ed_uk on August 19, 2005, at 15:41:11
> >I wonder what the mechanism for the akathesia is.
>
> I believe it's the alpha-2 antagonism. Clonidine, an alpha-2 agonist, appears to be an effective treatment for akathisia.
>
> Akathisia-like symptoms seem to occur mainly at high doses of Remeron.
>
> ~edI got restless legs at both 15 and much worse at 30mg. (one pill)
Marsha
Posted by ed_uk on August 20, 2005, at 15:37:02
In reply to Re: New warnings added to Remeron in the UK, posted by rod on August 19, 2005, at 18:56:52
Hi Roli :P
The mask-like face sounds like neuroleptic-induced Parkinsonism.
~Ed
Posted by ed_uk on August 20, 2005, at 15:38:29
In reply to Re: New warnings added to Remeron in the UK, posted by 4WD on August 19, 2005, at 21:57:05
Hi Marsha,
The restlessness does seem to be dose-dependent. Did you say you were going to try 7.5mg?
kind regards
ed
Posted by yxibow on August 20, 2005, at 23:02:26
In reply to Re: New warnings added to Remeron in the UK » 4WD, posted by ed_uk on August 20, 2005, at 15:38:29
I guess my black box would be extreme weight gain and slothy tiredness. But other than that, it was a godsend to my particular disorder, I think, because it had 5HT2 blockade similar to an antipsychotic.
The movement disorder warning is curious because I read a short anectodal journal brief of a handful of patients treated in Israel for depression who lost or had reduced their neuroleptic induced movement disorders while and only while they were on Remeron. So I guess its a case of different strokes for different folks as they say.
Posted by 4WD on August 20, 2005, at 23:28:17
In reply to Re: New warnings added to Remeron in the UK » 4WD, posted by ed_uk on August 20, 2005, at 15:38:29
> Hi Marsha,
>
> The restlessness does seem to be dose-dependent. Did you say you were going to try 7.5mg?
>
> kind regards
>
> edI'm going to try just the Lexapro at 7.5mg for a while first. If I still feel bad (apathy, fatigue, anxious), I'm going to try adding the Remeron at 7.5mg. And if the muscles tension gets worse at the increased dose of Lexapro, I'm going to try the Artane.
It was weird. I was more sedated at night after taking 30mg of Remeron than I was after taking 15mg. But on the day after, I was less sedated from the 30 than the 15. From this my pdoc suggested 7.5 Go figure.
Marsha
Posted by ed_uk on August 21, 2005, at 5:48:19
In reply to Re: New warnings added to Remeron in the UK, posted by yxibow on August 20, 2005, at 23:02:26
Hi yxibow!
>I guess my black box would be extreme weight gain....
WARNING: THIS DRUG MAY MAKE YOU FAT
>The movement disorder warning is curious because I read a short anectodal journal brief of a handful of patients treated in Israel for depression who lost or had reduced their neuroleptic induced movement disorders while and only while they were on Remeron. So I guess its a case of different strokes for different folks as they say.
It can sometimes help akathisia because it's a 5-HT2 antagonist....... but it can also make it worse because it's an NE alpha-2 antagonist.
Kind regards
~Ed
Posted by ed_uk on August 21, 2005, at 5:49:59
In reply to Re: New warnings added to Remeron in the UK » ed_uk, posted by 4WD on August 20, 2005, at 23:28:17
Hi Marsha,
I hope Lexapro works out :-)
~ed
Posted by Tom Twilight on August 21, 2005, at 6:10:19
In reply to New warnings added to Remeron in the UK, posted by ed_uk on August 19, 2005, at 9:17:22
First I should say I like Remeron/Mirtazapine
That said Remeron withdrawal can be nasty!
I stopped Remeron "cold turkey" because I foolishly read it rairly caused withdrawals, the next day I felt very anxious, I had to taper of it over two weeks, and even then I got horrible insomnia that went on for another week.
For me Remeron was harder to withdraw from than Effexor (which wasn't to bad for me)
Posted by ed_uk on August 21, 2005, at 6:37:12
In reply to I'm glad there warning Mirtazapine withdrawal!, posted by Tom Twilight on August 21, 2005, at 6:10:19
Hi Tom,
It's odd that they didn't list insomnia as a withdrawal symptom.
~Ed
Posted by 4WD on August 22, 2005, at 21:28:59
In reply to Re: I'm glad there warning Mirtazapine withdrawal! » Tom Twilight, posted by ed_uk on August 21, 2005, at 6:37:12
> Hi Tom,
>
> It's odd that they didn't list insomnia as a withdrawal symptom.
>
> ~EdThat's been one reason I've been reluctant to try it. For the first time in my life I'm going to sleep naturally and easily without meds. If I add Remeron, I'm projecting that at some point I will have to stop Remeron and then I will have insomnia again.
Just thinking ahead,
Marsha
Posted by LyndaK on August 26, 2005, at 2:44:26
In reply to Re: I'm glad there warning Mirtazapine withdrawal!, posted by 4WD on August 22, 2005, at 21:28:59
This has been very enlightening. In times past, when I've been doing really well, I've tried reducing my dose to see if I could maintain at a lower dose, but then the insomnia would come back and I interpreted that to mean that I still needed the higher dose -- I didn't know it was actually a withdrawal symptom (and my pdoc certainly didn't indicate to me that that might be a withdrawal symptom either!).
hmmmm,
Lynda
This is the end of the thread.
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