Psycho-Babble Medication Thread 984165

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Mirtazapine and blood sugar

Posted by mtdewcmu on April 30, 2011, at 15:09:55

I was reading about the alpha-2 adrenergic receptor in wikipedia, and I discovered that one of the effects of the receptor is to inhibit release of insulin and induce the release of glucagon from the pancreas. So, an alpha-2 agonist would tend to raise blood sugar, which you would expect as part of the fight-or-flight response. But mirtazapine is an alpha-2 antagonist, so it would be expected to lower blood sugar by causing the opposite response.

This is consistent with mirtazapine's side effect of inducing hunger and weight-gain. But I previously thought it had more to do with the 5-ht2c receptor. The idea that mirtazapine causes you to binge eat due to messing with your insulin and causing hypoglycemia is a darker, more sinister explanation, in my view, than the serotonin story.

I don't know if I like the idea of taking a drug that has the side effect of causing hyperinsulinemia and hypoglycemia, considering that other psychiatric drugs have already been shown to increase the risk of adult-onset diabetes.

 

Re: Mirtazapine and blood sugar

Posted by desolationrower on April 30, 2011, at 18:37:32

In reply to Mirtazapine and blood sugar, posted by mtdewcmu on April 30, 2011, at 15:09:55

Well, keep in mind it tends to affect presynaptic receptors more than postsynaptic. the overall effect is greater sympathetic activity.

I tend to think its 5ht2 and histmamine that are the main culprit - they both affect appetite. just changing the mix of fuel preference doesn't change overall metabolism

Yohimbine doesn't have those two effects (and has some other ones instead) but it is useful for weight loss.

-d/r

 

Re: Mirtazapine and blood sugar

Posted by Christ_empowered on April 30, 2011, at 18:42:18

In reply to Re: Mirtazapine and blood sugar, posted by desolationrower on April 30, 2011, at 18:37:32

I read a patent online that called for treating depression with amphetamines in the AM and remeron in the PM. I guess its kinda like "California Rocket Fuel," only with an amphetamine, not Effexor.

Higher doses=less sedation. Maybe higher doses also=less weight gain over the long haul?

 

Re: Mirtazapine and blood sugar » desolationrower

Posted by mtdewcmu on April 30, 2011, at 19:12:11

In reply to Re: Mirtazapine and blood sugar, posted by desolationrower on April 30, 2011, at 18:37:32

> Yohimbine doesn't have those two effects (and has some other ones instead) but it is useful for weight loss.
>

That is a good point that yohimbine doesn't cause weight gain. But maybe yohimbine's effects at other receptors cancels out this effect.

The claim that 5-ht2c strongly impacts appetite seems dubious because the effects it would predict, such as SSRIs causing weight-loss, have not proved true. A weight-loss drug that targeted 5-ht2c was recently rejected by the FDA. Evidently the effect was marginal.

 

Re: Mirtazapine and blood sugar

Posted by Phillipa on May 1, 2011, at 0:06:33

In reply to Re: Mirtazapine and blood sugar » desolationrower, posted by mtdewcmu on April 30, 2011, at 19:12:11

Remeron just never made me feel tired even with benzos. Dropped after a month of use. Phillipa

 

Re: Mirtazapine and blood sugar » Phillipa

Posted by mtdewcmu on May 1, 2011, at 1:11:57

In reply to Re: Mirtazapine and blood sugar, posted by Phillipa on May 1, 2011, at 0:06:33

> Remeron just never made me feel tired even with benzos. Dropped after a month of use. Phillipa

That's not necessarily a bad thing, since it's supposed to be an antidepressant.

 

Re: Mirtazapine and blood sugar

Posted by desolationrower on May 1, 2011, at 16:21:05

In reply to Re: Mirtazapine and blood sugar » desolationrower, posted by mtdewcmu on April 30, 2011, at 19:12:11

> > Yohimbine doesn't have those two effects (and has some other ones instead) but it is useful for weight loss.
> >
>
> That is a good point that yohimbine doesn't cause weight gain. But maybe yohimbine's effects at other receptors cancels out this effect.

no i think the mechanistic evidence is clear. Basically you are creating a situaiton in the body like when you haven't eaten for a while. The increased sympathetic activation releases stored glycose and fat and shifts to fat-burning. Seriously, the stuff is a great drug for increasing fat loss on a diet. Although that isn't to say it is very effective if you are overweight and not restricting calories, although it should increase metanolic rate and reduce hunger a bit, but it does more when you are skinny/excercising, because that is when alpha2 autoreceptors are more improtant.. Whereas antihistamines give you turbomunchies.

> The claim that 5-ht2c strongly impacts appetite seems dubious because the effects it would predict, such as SSRIs causing weight-loss, have not proved true. A weight-loss drug that targeted 5-ht2c was recently rejected by the FDA. Evidently the effect was marginal.

i wouldn't say its strong, no

-d/r

 

Re: Mirtazapine and blood sugar » desolationrower

Posted by mtdewcmu on May 1, 2011, at 16:54:46

In reply to Re: Mirtazapine and blood sugar, posted by desolationrower on May 1, 2011, at 16:21:05

>
> no i think the mechanistic evidence is clear. Basically you are creating a situaiton in the body like when you haven't eaten for a while. The increased sympathetic activation releases stored glycose and fat and shifts to fat-burning. Seriously, the stuff is a great drug for increasing fat loss on a diet. Although that isn't to say it is very effective if you are overweight and not restricting calories, although it should increase metanolic rate and reduce hunger a bit, but it does more when you are skinny/excercising, because that is when alpha2 autoreceptors are more improtant.. Whereas antihistamines give you turbomunchies.
>
> > The claim that 5-ht2c strongly impacts appetite seems dubious because the effects it would predict, such as SSRIs causing weight-loss, have not proved true. A weight-loss drug that targeted 5-ht2c was recently rejected by the FDA. Evidently the effect was marginal.
>
> i wouldn't say its strong, no

So you think the pro-appetite effect of mirtazapine has more to do with the antihistamine effect? I haven't noticed such a potent reaction to other antihistamines. I am impressed with what mirtazapine did to me. I was underweight for my entire adult life prior. But it may have in part coincided with some effect of hitting 30.

 

Re: Mirtazapine and blood sugar

Posted by desolationrower on May 2, 2011, at 4:04:39

In reply to Re: Mirtazapine and blood sugar » desolationrower, posted by mtdewcmu on May 1, 2011, at 16:54:46

> >
> > no i think the mechanistic evidence is clear. Basically you are creating a situaiton in the body like when you haven't eaten for a while. The increased sympathetic activation releases stored glycose and fat and shifts to fat-burning. Seriously, the stuff is a great drug for increasing fat loss on a diet. Although that isn't to say it is very effective if you are overweight and not restricting calories, although it should increase metanolic rate and reduce hunger a bit, but it does more when you are skinny/excercising, because that is when alpha2 autoreceptors are more improtant.. Whereas antihistamines give you turbomunchies.
> >
> > > The claim that 5-ht2c strongly impacts appetite seems dubious because the effects it would predict, such as SSRIs causing weight-loss, have not proved true. A weight-loss drug that targeted 5-ht2c was recently rejected by the FDA. Evidently the effect was marginal.
> >
> > i wouldn't say its strong, no
>
> So you think the pro-appetite effect of mirtazapine has more to do with the antihistamine effect? I haven't noticed such a potent reaction to other antihistamines. I am impressed with what mirtazapine did to me. I was underweight for my entire adult life prior. But it may have in part coincided with some effect of hitting 30.

well, the one thing i would say that might cause alpha2 antagonism to increase appetite is that if it reduces your depression, and ahedonia from depression caused you to eat less, then unfucking that might cause weight gain. but that is true for any antidepressant.

Mirtazapine is a really strong antihistamine. But i think the 5h2 is important too. The 5ht3 antagonism might add a little bit, it doesn't increase appetite per se but does reduce nausea.

-d/r

 

Re: Mirtazapine and blood sugar

Posted by sk85 on May 3, 2011, at 15:23:07

In reply to Re: Mirtazapine and blood sugar, posted by desolationrower on May 2, 2011, at 4:04:39

>The claim that 5-ht2c strongly impacts appetite seems dubious because the effects it would predict, such as SSRIs causing weight-loss, have not proved true.

SSRIs initally do lower food intake (5-HT2C agonism) but over long-term they desensitize and downregulate the receptor (i.e there are fewer functional receptors and the few still there are less responsive) and so the opposite effect starts to dominate and hunger ensues.

I constantly monitor my glucose and I'm taking Remeron at the moment and I have not noticed it to effect my glucose in any direction.

-Ikaros

 

Re: Mirtazapine and blood sugar » sk85

Posted by mtdewcmu on May 3, 2011, at 15:40:51

In reply to Re: Mirtazapine and blood sugar, posted by sk85 on May 3, 2011, at 15:23:07

> I constantly monitor my glucose and I'm taking Remeron at the moment and I have not noticed it to effect my glucose in any direction.
>

Thanks. That is good to know.

 

Re: Mirtazapine and blood sugar

Posted by desolationrower on May 3, 2011, at 20:51:37

In reply to Re: Mirtazapine and blood sugar, posted by sk85 on May 3, 2011, at 15:23:07

> >The claim that 5-ht2c strongly impacts appetite seems dubious because the effects it would predict, such as SSRIs causing weight-loss, have not proved true.
>
> SSRIs initally do lower food intake (5-HT2C agonism) but over long-term they desensitize and downregulate the receptor (i.e there are fewer functional receptors and the few still there are less responsive) and so the opposite effect starts to dominate and hunger ensues.
>
> I constantly monitor my glucose and I'm taking Remeron at the moment and I have not noticed it to effect my glucose in any direction.
>
> -Ikaros

What dose of remeron do you take?

-d/r

 

Re: Mirtazapine and blood sugar

Posted by sk85 on May 4, 2011, at 7:02:44

In reply to Re: Mirtazapine and blood sugar, posted by desolationrower on May 3, 2011, at 20:51:37

> > >The claim that 5-ht2c strongly impacts appetite seems dubious because the effects it would predict, such as SSRIs causing weight-loss, have not proved true.
> >
> > SSRIs initally do lower food intake (5-HT2C agonism) but over long-term they desensitize and downregulate the receptor (i.e there are fewer functional receptors and the few still there are less responsive) and so the opposite effect starts to dominate and hunger ensues.
> >
> > I constantly monitor my glucose and I'm taking Remeron at the moment and I have not noticed it to effect my glucose in any direction.
> >
> > -Ikaros
>
> What dose of remeron do you take?
>
> -d/r

I've been taking 15 mg/day for 2 months and a week ago upped the dose to 45 mg/day.

 

Re: Mirtazapine and blood sugar » mtdewcmu

Posted by Dinah on May 4, 2011, at 7:55:30

In reply to Mirtazapine and blood sugar, posted by mtdewcmu on April 30, 2011, at 15:09:55

I have diabetes and have been researching it recently. I'm not sure if I remember what I've been reading, but I think that insulin resistance is a major cause of weight gain as the body doesn't properly metabolize the glucose. One sign of insulin resistance is a big belly, particularly if that's not your previous body type. I also think I remember that not everyone develops diabetes with excess food consumption. It depends on your genes. Does your family have a history of diabetes? If so, it might be wise to be extra careful. I'm really iffy on this part, but I think that even nondiabetics with the gene for diabetes have a difference in their mitochondria and glucose processing.

I've also gotten a continuous glucose monitor this year, and it's clear that stress and anxiety is worse for my blood sugar than *anything* I eat. In periods of high stress, even with diabetic medication, my blood sugar hovered at 200-300+, while in low stress as now, it runs from 120 to spikes of over 200 depending on what I eat.

So I'd be tending to say that, for me, stress and anxiety may play more havoc with my blood sugar than what I might take to lower stress. But I could be wrong, even about myself. And certainly about others with different genes.

Do you have a meter? They finger stick kind are pretty inexpensive, and would give you a practical idea of your blood glucose under various conditions.

 

Re: Mirtazapine and blood sugar » Dinah

Posted by mtdewcmu on May 4, 2011, at 11:51:16

In reply to Re: Mirtazapine and blood sugar » mtdewcmu, posted by Dinah on May 4, 2011, at 7:55:30

> I have diabetes and have been researching it recently.

I am truly sorry to hear that. What a pain, and what a burden on your mind it must be.

> I'm not sure if I remember what I've been reading, but I think that insulin resistance is a major cause of weight gain as the body doesn't properly metabolize the glucose. One sign of insulin resistance is a big belly, particularly if that's not your previous body type.

It's a sign of metabolic syndrome. I'm not sure what it says specifically about IR.

A basic explanation for what insulin and glucagon do is that insulin is a major anabolic hormone, meaning it builds up (fats, and proteins, and other body structures), and glucagon is a major catabolic hormone, meaning it breaks down (fats, glycogen, etc). So if you favor having lots of insulin around, it tends to make you gain weight.

> I also think I remember that not everyone develops diabetes with excess food consumption.

It's not very well understood what causes type II diabetes. For obvious reasons, you can't do an experiment where you ask a group of people to eat too much for 20-30 years, and another group to eat a moderate amount for 20-30 years, and see what it does to diabetes rates. Even though a lot is said about it at present in a confident tone, there is a sore lack of proof. I will consider it a major breakthrough if/when the pathophysiology of type II diabetes and insulin resistance becomes well understood.

The proof that not everyone with excess food consumption develops diabetes is simple. Start asking fat people who are old enough if they have diabetes, and as soon as you find one who says no, you have proved it.

> It depends on your genes. Does your family have a history of diabetes?

One of my grandfathers died of complications of diabetes. Fortunately, I don't think he developed the disease until he was in his 80s, or nearly so.

> If so, it might be wise to be extra careful. I'm really iffy on this part, but I think that even nondiabetics with the gene for diabetes have a difference in their mitochondria and glucose processing.
>
> I've also gotten a continuous glucose monitor this year, and it's clear that stress and anxiety is worse for my blood sugar than *anything* I eat. In periods of high stress, even with diabetic medication, my blood sugar hovered at 200-300+, while in low stress as now, it runs from 120 to spikes of over 200 depending on what I eat.

That's interesting. I haven't seen a continuous glucose monitor.

Your blood sugar spikes are due to adrenal stress hormones, especially cortisol.

>
> So I'd be tending to say that, for me, stress and anxiety may play more havoc with my blood sugar than what I might take to lower stress. But I could be wrong, even about myself. And certainly about others with different genes.
>

You're right. Any effect of Remeron is probably peanuts compared to stress and other factors.

> Do you have a meter? They finger stick kind are pretty inexpensive, and would give you a practical idea of your blood glucose under various conditions.

I'm not going to start pricking my finger :). I had the opportunity to try it in nursing school, but I chickened out. But in a different frame of mind, I probably could do it.

 

Re: Mirtazapine and blood sugar » mtdewcmu

Posted by Dinah on May 4, 2011, at 20:21:47

In reply to Re: Mirtazapine and blood sugar » Dinah, posted by mtdewcmu on May 4, 2011, at 11:51:16

It's really not bad. Of course, I always joke I have asbestos fingertips even before regular testing. Today's meters need just a teensy amount compared to the old ones.

I hate my apple shape. I went from being T shaped to looking like a pregnant dumpling.

D*mn insulin resistance.

 

Re: Mirtazapine and blood sugar

Posted by desolationrower on May 5, 2011, at 18:33:03

In reply to Re: Mirtazapine and blood sugar » mtdewcmu, posted by Dinah on May 4, 2011, at 7:55:30

> I have diabetes and have been researching it recently. I'm not sure if I remember what I've been reading, but I think that insulin resistance is a major cause of weight gain as the body doesn't properly metabolize the glucose.

This is sort of popular in some descriptions, but its more complicated.

In a multicellular system, cells need a way of taking energy that they need, and when it is scarce to share the reduced amount. In obesity, the body becomes insulin resistant because they individual cells thing "hey, i am full, i will let other cells have that energy." But because of the odd situation evolutionarily (most plants and animals spend all day trying to get enough food, and only sometimes succeeding), they body can't handle the excess energy. Instead, it floats around in the blood as high blood sugar (glycating things, causing glaucoma, kidney disease, etc) and triglycerides (fatty liver, etc). The insulin resistance *prevents* weight gain, even though it is caused by and correlated with it. The energy in the blood should signal the brain to stop eating, and focus on otherh things like reproduction, sleep, etc. but it isn't effective against the modern convenient hyperpalatable food, bored humans, etc. Eventually, that signal actually becomes less effective (leptin resistance), making it harder to maintain a lower body weight.

This also explains why you can have metabolic syndrome even without being obese; those people became insulin resistant before they added much bodyfat, and vice-versa people who gain weight easily can have lower levels of metabolic syndrome. Also, drugs that reduce diabetes can cause weight gain: they reduce insulin resistance, increase fat deposition, and get the energy out of the blood. Excess calories are unhealthy when they are sitting in fat cells, but they are even worse for you floating around.


>One sign of insulin resistance is a big belly, particularly if that's not your previous body type. I also think I remember that not everyone develops diabetes with excess food consumption. It depends on your genes. Does your family have a history of diabetes? If so, it might be wise to be extra careful. I'm really iffy on this part, but I think that even nondiabetics with the gene for diabetes have a difference in their mitochondria and glucose processing.

Viceral fat, yes its worse. Obviously the best thing to do is get a glucose meter, do frequent blood sugar testing, and get your hba1c checked.

> I've also gotten a continuous glucose monitor this year, and it's clear that stress and anxiety is worse for my blood sugar than *anything* I eat. In periods of high stress, even with diabetic medication, my blood sugar hovered at 200-300+, while in low stress as now, it runs from 120 to spikes of over 200 depending on what I eat.

yes, normally stress means you need to run away from a lion or something, so you need energy available to burn.

> So I'd be tending to say that, for me, stress and anxiety may play more havoc with my blood sugar than what I might take to lower stress. But I could be wrong, even about myself. And certainly about others with different genes.
>
> Do you have a meter? They finger stick kind are pretty inexpensive, and would give you a practical idea of your blood glucose under various conditions.

+1

>It's a sign of metabolic syndrome. I'm not sure what it says specifically about IR.

i don't think they are directly linked.

anyway, viceral fat is the first to come off with physical activity. Meditation to reduce stress is also a good idea.

-d/r

 

Re: Mirtazapine and blood sugar » desolationrower

Posted by Dinah on May 8, 2011, at 21:42:52

In reply to Re: Mirtazapine and blood sugar, posted by desolationrower on May 5, 2011, at 18:33:03

It's rather encouraging to hear that visceral fat is the first to come off with exercise. I haven't really gained any weight lately. It's just redistributed itself. I *do* need to start exercising. Apart from all else we're planning a trip that won't be nearly as much fun if I have no stamina for walking.

I never really was sure of my grasp on the topic. I ran across things as I was researching the possibility of going on insulin. I know insulin can cause weight gain, and I'll need to be careful. Of course, if I exercise more, it might be less likely that I'll need to go on insulin.

Thanks, desolationrower.


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