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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 52. Go back in thread:
Posted by jono_in_adelaide on June 22, 2013, at 22:14:30
In reply to Remeron and Zoloft for MDD, my 13 yo daughter, posted by laurah952 on June 22, 2013, at 11:13:20
Remeron + Zoloft seems a reasonable combination, but if it doesn't work, there are plenty of other combinations out there that work on diferent neurotransmitters etc - for example, Zoloft + Welbutrin in the morning, and Risperidone at night.
A child/adolescent psychiatrist would seem an obvious choice, with some pretty intense therapy.
Very best of luck
Posted by laurah952 on June 23, 2013, at 7:37:14
In reply to Re: Remeron and Zoloft for MDD, my 13 yo daughter » laurah952, posted by europerep on June 22, 2013, at 12:38:48
Posted by laurah952 on June 23, 2013, at 7:38:45
In reply to Re: Remeron and Zoloft for MDD, my 13 yo daughter, posted by Phillipa on June 22, 2013, at 19:42:37
> Excellent advise. Definitely an adolescent psychiatrist. Best of luck. And welcome to babble. Phillipa
Thank you so much!
Laura
Posted by laurah952 on June 23, 2013, at 7:40:17
In reply to Re: Remeron and Zoloft for MDD, my 13 yo daughter, posted by Jeroen on June 22, 2013, at 20:26:49
Thank you, I have the feeling I'll be needing some help..
Laura
Posted by laurah952 on June 23, 2013, at 8:40:57
In reply to Re: Remeron and Zoloft for MDD, my 13 yo daughter, posted by jono_in_adelaide on June 22, 2013, at 22:14:30
Remeron + Zoloft seems a reasonable combination, but if it doesn't work, there are plenty of other combinations out there that work on diferent neurotransmitters etc - for example, Zoloft + Welbutrin in the morning, and Risperidone at night.
A child/adolescent psychiatrist would seem an obvious choice, with some pretty intense therapy.
Hi and thanks for the reply,
My daughter's pdoc (yes, an adolescent psychiatrist for 22 yrs) advised me to continue Zoloft 100mg, stop Seroquel, start Remeron, and if Remeron wasn't tolerated, to re-start the Seroquel again. I just don't understand why an anti-psychotic or tetracyclic antidepressant as opposed to a mood stabilizer.
One thing to note about my daughter's thinking, and perhaps why Seroquel was chosen at first. She was completely consumed and obsessed with thoughts of suicide. She was supposed to keep a diary, so to speak, as per her therapist, but she wrote over and over and over; pages upon pages of ways she was going to kill herself. She had an exact date set, and made her plan "foolproof" in that she was going to do three things to end her life; suffocate herself while cutting her wrists while swallowing a bottle of pills. (that's when she became an inpatient at an adolescent psych unit)
This is not the case now, but suicidal thoughts still enter her mind, approx. 10% of the time. The seroquel zeroed out these thoughts, but at the price of becoming a zombie at the higher doses. She also has insomnia which doesn't help - she just needs to get up in the am.
Bottom line - she is much more outgoing now, finds happiness in her friends and life again, yet her moods are up and down all day long (not overly so in either direction, but just enough to need something more) She's been on Zoloft 100mg for 7 weeks, and Seroquel 50mg for maybe a week or two. (after coming down from 200mg started at the same time as the Zoloft)
I apologize for, well... babbling on (pun intended) and hope I've made some sense.
Thanks for any and all help - I've got to corner the pdoc, ask her to listen carefully to my questions, and give me answers w/o deviating from the topic at hand. Been difficult.
Thank you all!
Laura
Posted by laurah952 on June 23, 2013, at 8:49:28
In reply to Remeron and Zoloft for MDD, my 13 yo daughter, posted by laurah952 on June 22, 2013, at 11:13:20
Hello,
I wanted to post that I am aware that Remeron hasn't been studied in adolescents as far as I know. Any experience with the drug combined with Zoloft is so much appreciated.
Can anyone shed some light on "California Rocket fuel"? Would this combo be an example, or is that solely for an SSRI, NSRI combo? The term scares me as well.
Anyone experience bizarre, terrifying nightmares with Remeron?
Thank you all so much!
Laura
Posted by laurah952 on June 23, 2013, at 8:58:44
In reply to Re: Remeron and Zoloft for MDD, my 13 yo daughter (nm), posted by laurah952 on June 23, 2013, at 7:37:14
Hi,
My reply is not here, and I have replied to several posts with success today. Could it contain "key words" that a moderator would need to look at before the post can "go through"??
I'm new here, so I'm feeling my way through the workings of the forum.
Thanks!
Laura
Posted by laurah952 on June 23, 2013, at 10:38:24
In reply to Re: Remeron and Zoloft for MDD, my 13 yo daughter » laurah952, posted by europerep on June 22, 2013, at 12:38:48
2.) What do you mean exactly by mood swings? Does your daughter's mood vary from depressed to "normal", or to the opposite of depressed: being happy, talkative, outgoing, impulsive, possibly even reckless and "over the top"? If the latter is the case, this would suggest that she may actually not be suffering from "pure" depression (MDD), but from some type of bipolar disorder. This would require a different treatment strategy.
Hello,
I looked for my reply and found only the header - must have checked "no message"? Not sure that makes sense.
Anyway, thank you very much for your reply. I believe my daughter is going from normal happy to depressed all throughout the day. I've only observed over-the-top "moods" as it pertains to her recklessness. She engaged in activity that, with a little imbalance, would have ended her life. When asked about this, she replied, "If I live, cool - if I die, cool" Totally broke my heart, so I'm working on informing myself of her condition, considering bipolar II, (which I was recently diagnosed with myself), and trying to get direct answers to my questions from her Adolescent Psychiatrist - that's been difficult. The doc says she may be bipolar, but isn't sure yet. How long would a diagnosis take? She's seen her 3 times, and has her therapists reports, along w/ reports from all the docs at the inpatient hospital.
I asked for a mood stabilizer for her (instead of the anti-psychotic, Seroquel, which I know has an off-label use for bipolar) along with the Zoloft 100mg, but she decided on Remeron. I can't get a straight answer from the doc as to why not a new mood stabilizer - she tends to go off on a tangent. I'm sure she has her reasons - one of which was stated that she had the worst depression/suicidal ideation she'd ever seen. Terrifying right there...
I do suspect bi-polar, so maybe we should stick w/ the Seroquel? The doc said to do what I wanted as it refers to Remeron vs. Seroquel. (is that a red flag that I need a new doc? - there are no others in my plan for adolescents)
Taylor needs sleep she can wake from more easily, and something so her moods don't drop/dip, etc... along with an antidepressant.
I'm so confused...
I'm in NY, and have insurance...
Thanks for any light you may be able to shed on this! I just really appreciate it
Laura
Posted by Lou Pilder on June 23, 2013, at 14:25:06
In reply to Remeron and Zoloft for MDD, my 13 yo daughter, posted by laurah952 on June 22, 2013, at 11:13:20
> Hello,
>
> This is my first post, so I hope I'm in the right area of the forum. My daughter (13) HAS MDD, and is complaining of mood swings. She was hospitalized as she was consumed with thoughts of suicide 70% of the time. She was given ZOLOFT 100mg, and SEROQUEL (has been on up to 300 mg - but is now down to 50mg) The drop in SEROQUEL made her mood swings severe, and she was cutting more than ever. At higher levels of Seroquel, she'd walk into walls, and not fully wake-up until afternoon. She seems stabilized at 50mg, but is still having some mood swings, not sleeping well, and the suicidal thoughts remain at 10%. (which is remarkable, as she's only been on meds for about 3 mos.)
>
> Her pdoc just switched her from SEROQUEL to REMERON (along with the 100mg zoloft) I'm a little nervous about this combo from what I've read.
>
> If anyone can shed any light on this combination, and what it might do for her??... i.e. is remeron better than seroquel for MDD with mood swings, insomnia, etc.. She says she doesn't have anxiety, but the pdoc maintains that her depression has been the worst she's seen in her medical career.
>
> After that information, the doc really didn't answer my questions, but told me to use what I wanted - the seroquel or the remeron. (if remeron wasn't tolerated, switch back to seroquel) I'm really confused; ANY help is appreciated!!
>
> (note that I don't know the dosage of the Remeron yet as my husband took my daughter to the pdoc and I haven't picked it up yet)
>
> Thanks!laurah,
You wrote,[...could anyone shed any light...ANY help is appreciated...].
If you continue with what you are doing to your child, she could be dead today or tomorrow or maybe some day after that. You see, the chemicals that you are drugging your daughter with, in collaboration with a psychiatrist, have the potential to cause death via what is known as serotonin syndrome, as one way those drugs could kill her. But it is much more than that. I am prevented from posting here what IMHHHO could save your daughter's life, prevent life-ruining conditions or addiction due to prohibitions posted to me here by Mr Hsiung. So I am prevented from shedding the light that IMHHHO could heal your daughter. You could go to the administrative board here and review post by me and see years of outstanding requests/notifications from me to Mr Hsiung and his deputy now and his past deputies. I think that by you doing that, you could have your psychiatrist email me and I could advise him/her and then he/she could relay that to you.
As to the suicide thoughts that you posted here about your daughter, be advised that the drugs that she is given can INCREASE suicidal thinking. And also, when taking these drugs together, the adverse effects are increased exponentially.
So can she have a way out? I know of a way out, but if you stop the drugs she could go into a mind-altered state to be compelled to kill herself or others, even commit mass-murder.
Lou
Posted by Lou Pilder on June 23, 2013, at 14:45:43
In reply to Lou's response- » laurah952, posted by Lou Pilder on June 23, 2013, at 14:25:06
> > Hello,
> >
> > This is my first post, so I hope I'm in the right area of the forum. My daughter (13) HAS MDD, and is complaining of mood swings. She was hospitalized as she was consumed with thoughts of suicide 70% of the time. She was given ZOLOFT 100mg, and SEROQUEL (has been on up to 300 mg - but is now down to 50mg) The drop in SEROQUEL made her mood swings severe, and she was cutting more than ever. At higher levels of Seroquel, she'd walk into walls, and not fully wake-up until afternoon. She seems stabilized at 50mg, but is still having some mood swings, not sleeping well, and the suicidal thoughts remain at 10%. (which is remarkable, as she's only been on meds for about 3 mos.)
> >
> > Her pdoc just switched her from SEROQUEL to REMERON (along with the 100mg zoloft) I'm a little nervous about this combo from what I've read.
> >
> > If anyone can shed any light on this combination, and what it might do for her??... i.e. is remeron better than seroquel for MDD with mood swings, insomnia, etc.. She says she doesn't have anxiety, but the pdoc maintains that her depression has been the worst she's seen in her medical career.
> >
> > After that information, the doc really didn't answer my questions, but told me to use what I wanted - the seroquel or the remeron. (if remeron wasn't tolerated, switch back to seroquel) I'm really confused; ANY help is appreciated!!
> >
> > (note that I don't know the dosage of the Remeron yet as my husband took my daughter to the pdoc and I haven't picked it up yet)
> >
> > Thanks!
>
> laurah,
> You wrote,[...could anyone shed any light...ANY help is appreciated...].
> If you continue with what you are doing to your child, she could be dead today or tomorrow or maybe some day after that. You see, the chemicals that you are drugging your daughter with, in collaboration with a psychiatrist, have the potential to cause death via what is known as serotonin syndrome, as one way those drugs could kill her. But it is much more than that. I am prevented from posting here what IMHHHO could save your daughter's life, prevent life-ruining conditions or addiction due to prohibitions posted to me here by Mr Hsiung. So I am prevented from shedding the light that IMHHHO could heal your daughter. You could go to the administrative board here and review post by me and see years of outstanding requests/notifications from me to Mr Hsiung and his deputy now and his past deputies. I think that by you doing that, you could have your psychiatrist email me and I could advise him/her and then he/she could relay that to you.
> As to the suicide thoughts that you posted here about your daughter, be advised that the drugs that she is given can INCREASE suicidal thinking. And also, when taking these drugs together, the adverse effects are increased exponentially.
> So can she have a way out? I know of a way out, but if you stop the drugs she could go into a mind-altered state to be compelled to kill herself or others, even commit mass-murder.
> Lou
>Laurah,
If you could show the following statistics to you psychiatrist, he/she could then answer your questions and if the psychiatrist will not give you a straight answer, what could that tell you?
You see, giving these drugs to a 13 year old is (redacted by respondent) and I would really like for this doctor that is giving you daughter these drugs to post here so that I can post my response to him/her.
Lou
http://www.ehealthme.com/ds/zoloft/death
http://www.ehealthme.com/ds/remeron/death
Posted by Lou Pilder on June 23, 2013, at 14:55:04
In reply to Lou's response-death by drugs, zoloft,remeron, posted by Lou Pilder on June 23, 2013, at 14:45:43
> > > Hello,
> > >
> > > This is my first post, so I hope I'm in the right area of the forum. My daughter (13) HAS MDD, and is complaining of mood swings. She was hospitalized as she was consumed with thoughts of suicide 70% of the time. She was given ZOLOFT 100mg, and SEROQUEL (has been on up to 300 mg - but is now down to 50mg) The drop in SEROQUEL made her mood swings severe, and she was cutting more than ever. At higher levels of Seroquel, she'd walk into walls, and not fully wake-up until afternoon. She seems stabilized at 50mg, but is still having some mood swings, not sleeping well, and the suicidal thoughts remain at 10%. (which is remarkable, as she's only been on meds for about 3 mos.)
> > >
> > > Her pdoc just switched her from SEROQUEL to REMERON (along with the 100mg zoloft) I'm a little nervous about this combo from what I've read.
> > >
> > > If anyone can shed any light on this combination, and what it might do for her??... i.e. is remeron better than seroquel for MDD with mood swings, insomnia, etc.. She says she doesn't have anxiety, but the pdoc maintains that her depression has been the worst she's seen in her medical career.
> > >
> > > After that information, the doc really didn't answer my questions, but told me to use what I wanted - the seroquel or the remeron. (if remeron wasn't tolerated, switch back to seroquel) I'm really confused; ANY help is appreciated!!
> > >
> > > (note that I don't know the dosage of the Remeron yet as my husband took my daughter to the pdoc and I haven't picked it up yet)
> > >
> > > Thanks!
> >
> > laurah,
> > You wrote,[...could anyone shed any light...ANY help is appreciated...].
> > If you continue with what you are doing to your child, she could be dead today or tomorrow or maybe some day after that. You see, the chemicals that you are drugging your daughter with, in collaboration with a psychiatrist, have the potential to cause death via what is known as serotonin syndrome, as one way those drugs could kill her. But it is much more than that. I am prevented from posting here what IMHHHO could save your daughter's life, prevent life-ruining conditions or addiction due to prohibitions posted to me here by Mr Hsiung. So I am prevented from shedding the light that IMHHHO could heal your daughter. You could go to the administrative board here and review post by me and see years of outstanding requests/notifications from me to Mr Hsiung and his deputy now and his past deputies. I think that by you doing that, you could have your psychiatrist email me and I could advise him/her and then he/she could relay that to you.
> > As to the suicide thoughts that you posted here about your daughter, be advised that the drugs that she is given can INCREASE suicidal thinking. And also, when taking these drugs together, the adverse effects are increased exponentially.
> > So can she have a way out? I know of a way out, but if you stop the drugs she could go into a mind-altered state to be compelled to kill herself or others, even commit mass-murder.
> > Lou
> >
>
> Laurah,
> If you could show the following statistics to you psychiatrist, he/she could then answer your questions and if the psychiatrist will not give you a straight answer, what could that tell you?
> You see, giving these drugs to a 13 year old is (redacted by respondent) and I would really like for this doctor that is giving you daughter these drugs to post here so that I can post my response to him/her.
> Lou
> http://www.ehealthme.com/ds/zoloft/death
> http://www.ehealthme.com/ds/remeron/deathlaurah,
Your mention of suicide thoughts here by your daughter is something that I need to warn you about. You see, taking these drugs together increases suicidal thinking.
Lou
http://www.ehealthme.com/zoloft-and-remeron/suicide+attempt
Posted by Lou Pilder on June 23, 2013, at 14:59:03
In reply to Lou's response-suicide by drugs, zoloft,remeron, posted by Lou Pilder on June 23, 2013, at 14:55:04
> > > > Hello,
> > > >
> > > > This is my first post, so I hope I'm in the right area of the forum. My daughter (13) HAS MDD, and is complaining of mood swings. She was hospitalized as she was consumed with thoughts of suicide 70% of the time. She was given ZOLOFT 100mg, and SEROQUEL (has been on up to 300 mg - but is now down to 50mg) The drop in SEROQUEL made her mood swings severe, and she was cutting more than ever. At higher levels of Seroquel, she'd walk into walls, and not fully wake-up until afternoon. She seems stabilized at 50mg, but is still having some mood swings, not sleeping well, and the suicidal thoughts remain at 10%. (which is remarkable, as she's only been on meds for about 3 mos.)
> > > >
> > > > Her pdoc just switched her from SEROQUEL to REMERON (along with the 100mg zoloft) I'm a little nervous about this combo from what I've read.
> > > >
> > > > If anyone can shed any light on this combination, and what it might do for her??... i.e. is remeron better than seroquel for MDD with mood swings, insomnia, etc.. She says she doesn't have anxiety, but the pdoc maintains that her depression has been the worst she's seen in her medical career.
> > > >
> > > > After that information, the doc really didn't answer my questions, but told me to use what I wanted - the seroquel or the remeron. (if remeron wasn't tolerated, switch back to seroquel) I'm really confused; ANY help is appreciated!!
> > > >
> > > > (note that I don't know the dosage of the Remeron yet as my husband took my daughter to the pdoc and I haven't picked it up yet)
> > > >
> > > > Thanks!
> > >
> > > laurah,
> > > You wrote,[...could anyone shed any light...ANY help is appreciated...].
> > > If you continue with what you are doing to your child, she could be dead today or tomorrow or maybe some day after that. You see, the chemicals that you are drugging your daughter with, in collaboration with a psychiatrist, have the potential to cause death via what is known as serotonin syndrome, as one way those drugs could kill her. But it is much more than that. I am prevented from posting here what IMHHHO could save your daughter's life, prevent life-ruining conditions or addiction due to prohibitions posted to me here by Mr Hsiung. So I am prevented from shedding the light that IMHHHO could heal your daughter. You could go to the administrative board here and review post by me and see years of outstanding requests/notifications from me to Mr Hsiung and his deputy now and his past deputies. I think that by you doing that, you could have your psychiatrist email me and I could advise him/her and then he/she could relay that to you.
> > > As to the suicide thoughts that you posted here about your daughter, be advised that the drugs that she is given can INCREASE suicidal thinking. And also, when taking these drugs together, the adverse effects are increased exponentially.
> > > So can she have a way out? I know of a way out, but if you stop the drugs she could go into a mind-altered state to be compelled to kill herself or others, even commit mass-murder.
> > > Lou
> > >
> >
> > Laurah,
> > If you could show the following statistics to you psychiatrist, he/she could then answer your questions and if the psychiatrist will not give you a straight answer, what could that tell you?
> > You see, giving these drugs to a 13 year old is (redacted by respondent) and I would really like for this doctor that is giving you daughter these drugs to post here so that I can post my response to him/her.
> > Lou
> > http://www.ehealthme.com/ds/zoloft/death
> > http://www.ehealthme.com/ds/remeron/death
>
> laurah,
> Your mention of suicide thoughts here by your daughter is something that I need to warn you about. You see, taking these drugs together increases suicidal thinking.
> Lou
> http://www.ehealthme.com/zoloft-and-remeron/suicide+attemptcorrection:
http://www.ehealthme.com/zoloft-and-remeron/suicide-attempt
Posted by SLS on June 23, 2013, at 17:09:49
In reply to Remeron and Zoloft for MDD, my 13 yo daughter, posted by laurah952 on June 22, 2013, at 11:13:20
Hi.
I am not a doctor.
> Her pdoc just switched her from SEROQUEL to REMERON (along with the 100mg zoloft) I'm a little nervous about this combo from what I've read.
What have you read?
From Lou Pilder: "You see, the chemicals that you are drugging your daughter with, in collaboration with a psychiatrist, have the potential to cause death via what is known as serotonin syndrome"
Don't worry, this is not a likely outcome. Reports of Remeron producing serotonin syndrome when combined with a SSRI drug like Zoloft are rare, and they fail to establish cause and effect.
Just in case there is a rare serotonin syndrome reaction, these are the symptoms to be aware of:
------------------------------------------
http://www.mayoclinic.com/health/serotonin-syndrome/DS00860/DSECTION=symptoms
Serotonin syndrome symptoms typically occur within several hours of taking a new drug or increasing the dose of a drug you're already taking. Signs and symptoms include:
Agitation or restlessness
Confusion
Rapid heart rate and high blood pressure
Dilated pupils
Loss of muscle coordination or twitching muscles
Heavy sweating
Diarrhea
Headache
Shivering
Goose bumpsSevere serotonin syndrome can be life-threatening. Signs and symptoms include:
High fever
Seizures
Irregular heartbeat
UnconsciousnessWhen to see a doctor
If you suspect you might have serotonin syndrome after starting a new drug or increasing the dose of a drug you're already taking, call your doctor right away or go to the emergency room. If you have severe or rapidly worsening symptoms, seek emergency treatment immediately.---------------------------------------
If Seroquel acted as an antidepressant in your daughter's case, a drug from the same class, Latuda (lurasidone), is currently available and close to being approved by FDA for bipolar depression (similar to Seroquel). Latuda is different from Seroquel in ways that make it less likely to produce somnolence (oversleeping) and other the antihistamine effects that occur with Seroquel.
Both Seroquel and Remeron have antihistamergric properties. Combining them might produce additional sedation.
What other drug treatments has the doctor tried with your daughter? What types of psychotherapy have been tried? Is there any family history of bipolar disorder?
Bipolar disorder typically occurs earlier in life than does unipolar MDD, even if the initial presentation is depression only. Mood swings and agitation are likely symptoms of bipolar disorder. If this is the case, mood stabilizers like lithium or Trileptal might be indicated. Zyprexa is a good drug to use in an emergency when suicidality is present. Lithium can help with this, too, but takes longer to work. Since Zyprexa can produce undesirable metabolic changes in blood sugar and body weight, along with the potential to produce diabetes, it might be better to use it as a temporary measure.
One step at a time...
- Scott
Posted by europerep on June 23, 2013, at 17:19:56
In reply to Re: Remeron and Zoloft for MDD, my 13 yo daughter » europerep, posted by laurah952 on June 23, 2013, at 10:38:24
> Hello,
>
> I looked for my reply and found only the header - must have checked "no message"? Not sure that makes sense.
>
> Anyway, thank you very much for your reply. I believe my daughter is going from normal happy to depressed all throughout the day. I've only observed over-the-top "moods" as it pertains to her recklessness. She engaged in activity that, with a little imbalance, would have ended her life. When asked about this, she replied, "If I live, cool - if I die, cool" Totally broke my heart, so I'm working on informing myself of her condition, considering bipolar II, (which I was recently diagnosed with myself), and trying to get direct answers to my questions from her Adolescent Psychiatrist - that's been difficult. The doc says she may be bipolar, but isn't sure yet. How long would a diagnosis take? She's seen her 3 times, and has her therapists reports, along w/ reports from all the docs at the inpatient hospital.
>
> I asked for a mood stabilizer for her (instead of the anti-psychotic, Seroquel, which I know has an off-label use for bipolar) along with the Zoloft 100mg, but she decided on Remeron. I can't get a straight answer from the doc as to why not a new mood stabilizer - she tends to go off on a tangent. I'm sure she has her reasons - one of which was stated that she had the worst depression/suicidal ideation she'd ever seen. Terrifying right there...
>
> I do suspect bi-polar, so maybe we should stick w/ the Seroquel? The doc said to do what I wanted as it refers to Remeron vs. Seroquel. (is that a red flag that I need a new doc? - there are no others in my plan for adolescents)
>
> Taylor needs sleep she can wake from more easily, and something so her moods don't drop/dip, etc... along with an antidepressant.
>
> I'm so confused...
>
> I'm in NY, and have insurance...
>
> Thanks for any light you may be able to shed on this! I just really appreciate it
>
> LauraHey there,
yeah, it happens regularly that people tick the "no message" box instead of the "add name of previous poster" one. I kind of suspected that when I saw your (nm) post ;-)...
First of all, I would like to suggest that you don't pay attention to the replies above this one made by the member Lou Pilder. To put it briefly, in my opinion he is very very ill, probably doesn't get any treatment, and should have been banned from this board a long time ago. If you want to learn more, scroll down to the bottom of the page and click on the "Administration" board. (But to be honest, I'd say you better do not, because it is extremely confusing. I have given up on following this endless drama a long time ago.)
Then, looking into a diagnosis of some form of bipolar disorder sounds reasonable, especially if you are dealing with it yourself as well. A final, definite diagnosis might actually take some time, but a first, preliminary diagnosis could be made rather quickly, with the help of questionnaires to investigate whether there have been prior hypomanic or manic episodes, etc. This is how this usually works. I was also gonna suggest in-patient treatment for your daughter, but from your text I gather that she has already had that? What happened during that treatment, and did she benefit from it? And what was her diagnosis upon discharge?
When your daughter switches drugs, for example from quetiapine (Seroquel) to mirtazapine (Remeron), I think it's very important that you keep a good eye on her symptoms, and especially if anything suggests that she is getting hypomanic or hypomanic. Potent antidepressants (and combinations thereof) can induce manic episodes, even if it happens rather rarely, so it'd be important to keep that in mind.
I would suggest to deal with this step by step, and the first step should probably be finding the right doctor (or team of doctor and psychotherapist), and getting a good diagnosis. There are good psychiatric institutions in NY as far as I know, for example the Mount Sinai School of Medicine in NYC, and probably others as well. But I have no idea whether they do out-patient treatments and so on, but it may be worth checking that out.
And, referring to your question, I do think that the fact that the current doctor said it's up to you whether you go with Seroquel or Remeron is kind of strange. As I said, they are two very different drugs, so I don't really get that. And Remeron does have a reputation of being very sedating, so if Taylor (that's her name right?) already has problems with sleepiness (that are not caused by the Seroquel), giving her Remeron may not be ideal. But it would be important for you to talk to the doctor and ask her about that, I don't want to evaluate her work, all the more via the internet...
That's all I can think of right now, and it's already late over here so I need to go to bed :)... I hope I'm helping you somewhat, and don't hesitate to ask more questions (to me or the others)... bye!
ER
Posted by Phillipa on June 23, 2013, at 18:44:53
In reply to Re: Remeron and Zoloft for MDD, my 13 yo daughter » laurah952, posted by SLS on June 23, 2013, at 17:09:49
Mom Laura said she also is bipolar. Laura what meds are you currently taking? Frequently the meds that work for a family member can also work for another family member. Phillipa
Posted by LAURAH952 on June 23, 2013, at 20:53:04
In reply to Re: Remeron and Zoloft for MDD, my 13 yo daughter, posted by Phillipa on June 23, 2013, at 18:44:53
> Mom Laura said she also is bipolar. Laura what meds are you currently taking? Frequently the meds that work for a family member can also work for another family member. Phillipa
Hello,
I take:
CYMBALTA 60mg (works well)
KLONOPIN 6mg (for 25 years, panic attacks which daughter does not have)
TRAZADONE 50-100 prn
Just stopped CARBAMAZEPINE 400mg - doesn't seem to help, more depressed - have tried so many other mood stabilizers and none really work - my bipolar II just isn't bad enough to keep trying.Thanks!
Laura
Posted by Phillipa on June 23, 2013, at 21:26:01
In reply to Re: Remeron and Zoloft for MDD, my 13 yo daughter » Phillipa, posted by LAURAH952 on June 23, 2013, at 20:53:04
Laura so in a way you are ahead of the game as you may have the same as Daughter so then what didn't work for you might be a med to skip. How bout trileptal as a mood stabilizer? Didn't make me anxious. It was an add on for depression more dysthymia. Low dose. Phillipa
Posted by LAURAH952 on June 23, 2013, at 22:32:13
In reply to Re: Remeron and Zoloft for MDD, my 13 yo daughter » laurah952, posted by europerep on June 23, 2013, at 17:19:56
OH MY GOD!!! I'm so new at this; what Lou Pilder went on about has me hysterically in tears, and more scared to death than ever before!!! Thank you so much for shedding light on that!!!!
I was only recently diagnosed with bi-polar II based mostly on my rapid speech and insomnia. Not a single med has made a difference, and I don't have mood swings - just feeling ok to depressed at times. Still, I will be asking Taylor's psychiatrists about it.
Taylor was an inpatient for 10 days, and her diagnosis was MDD. The meds (zoloft and seroquel) were started at that time. She showed some improvement and was finally sleeping.
She really showed great improvement a few weeks after her out-patient pdoc increased her zoloft, and decreased her seroquel. (100mg, and 200mg respectively) She then lowered the seroquel to 100mg and she was even better, as she was less tired during the day.
She went from laying in bed all weekend, crying at school, not seeing friends, cutting herself, and completely obsessed with thoughts of suicide to going out with friends, enjoying herself, and only having brief moments of suicidal thoughts with minor ups and downs. (still not good enough)
Taylor wanted to get off the Seroquel 100mg completely (daytime fatigue), and her pdoc tapered the med 25mg every 4 days until she was on 25mg. During this time, her mood swings were raging, and she started cutting again. I think it was done too quickly for her. A consulting pdoc (her pdoc was out of town) suggested going back to 50mg Seroquel, and a few days after that, her mood swings subsided considerably. She saw her pdoc when she came back a few days later, and that's when she decided on the Remeron. Taylor has insomnia, so I think that's why she chose Remeron. (I wish I was at that appt. - my husband went)
Taylor wants off Seroquel, and always has - we have a child psychologist in the family who says a child shouldn't be on it for a lengthy time. We also have a "neuro psychologist" who also hates Seroquel for an extended med (and who is wary of Remeron/Zoloft combo until she researches it further) These people have voiced their opinions where Taylor could hear, so naturally, she's scared to take it.
I need to talk to her psychiatrist again, with my questions in hand. Her therapist works with CBT if that makes sense, and Taylor really opens up to her.
I also set up an appt. to have her see my Nurse Practitioner who's been maintaining my psych meds - for an intake and to see their child pdoc who's there twice a month, which is the best I can find with this new insurance. I'm thinking about cancelling that appointment, but perhaps I shouldn't.
Should Taylor start on Remeron, I will watch her like a hawk; I researched what to look for. Thanks for that info..
If it were up to Taylor, she'd be only on the zoloft, and I may ask if it's not a bad idea....
Thank you so much once again!
Laura
Posted by Phillipa on June 23, 2013, at 23:17:36
In reply to Re: Remeron and Zoloft for MDD, my 13 yo daughter » europerep, posted by LAURAH952 on June 23, 2013, at 22:32:13
Sounds like you have a lot of personal resources available also. Also at age 13 hormones are raging and might be causing a lot of mood swings? Phillipa
Posted by LAURAH952 on June 23, 2013, at 23:23:25
In reply to Re: Remeron and Zoloft for MDD, my 13 yo daughter » LAURAH952, posted by Phillipa on June 23, 2013, at 21:26:01
> Laura so in a way you are ahead of the game as you may have the same as Daughter so then what didn't work for you might be a med to skip. How bout trileptal as a mood stabilizer? Didn't make me anxious. It was an add on for depression more dysthymia. Low dose. Phillipa
Hi and thanks,
I'm going to research trileptal and ask the doc - 1st I suppose I need a formal diagnosis of bipolar for her.
- Laura
Posted by LAURAH952 on June 23, 2013, at 23:28:31
In reply to Re: Remeron and Zoloft for MDD, my 13 yo daughter » LAURAH952, posted by Phillipa on June 23, 2013, at 23:17:36
> Sounds like you have a lot of personal resources available also. Also at age 13 hormones are raging and might be causing a lot of mood swings? Phillipa
Hi Phillipa,
Yes, many resources, so it helps. Most against multiple meds. (Yes, 13 year old hormones probably have something to do with this)
Thanks!
Laura
Posted by LAURAH952 on June 23, 2013, at 23:35:46
In reply to Re: Remeron and Zoloft for MDD, my 13 yo daughter, posted by LAURAH952 on June 23, 2013, at 23:28:31
Hello all,
With the go-ahead from my daughter's pdoc, I'm contemplating a slow taper off Seroquel, and not adding Remeron or anything else; Just keeping her on 100mg Zoloft.
She's convinced that these other meds are hurting her, but believes in the Zoloft. (I'm thinking reverse placebo effect here)
Does anyone have ANY thoughts on this after reading my exhaustive account of her depression?
Thanks to all of you! I really appreciate it.
Laura
Posted by SLS on June 24, 2013, at 0:16:53
In reply to Thinking of keeping my daughter on Zoloft only, posted by LAURAH952 on June 23, 2013, at 23:35:46
> Hello all,
>
> With the go-ahead from my daughter's pdoc, I'm contemplating a slow taper off Seroquel, and not adding Remeron or anything else; Just keeping her on 100mg Zoloft.
>
> She's convinced that these other meds are hurting her, but believes in the Zoloft. (I'm thinking reverse placebo effect here)This is sometimes called the "nocebo" effect. It is true, though, that someone may feel more depressed on certain drugs. Also, someone who is hyperthymic will hate being slowed down by drugs, even if they are producing the desired effect of stabilizing mood.
> Does anyone have ANY thoughts on this after reading my exhaustive account of her depression?
>
> Thanks to all of you! I really appreciate it.
> LauraIf I were diagnosed as having MDD, I would also want to take Zoloft by itself. If Zoloft monotherapy works, that's great. To try it at this juncture is a reasonable decision. However, if Taylor is bipolar, it is possible that something that acts as a mood stabilizer or anti-manic will be necessary to treat any mood swings, racing thoughts, or agitation that might emerge. Suicidality also occurs in a manic state, especially in mixed-states. The presence of a bipolar mixed-state might explain things.
- Scott
Posted by LAURAH952 on June 24, 2013, at 7:43:00
In reply to Re: Thinking of keeping my daughter on Zoloft only » LAURAH952, posted by SLS on June 24, 2013, at 0:16:53
Hi Scott,
Taylor's pdoc and her therapist haven't given me a definite answer as to whether or not she has bipolar disorder. Having her try Zoloft alone, may show that she either needs a mood stabilizer, or doesn't. That is my hope.
Being on 300mg Seroquel in the hospital, walking into walls, and feeling "zeroed-out" all the time might make anyone dislike the drug. I've also never seen mood swings in her until the meds were introduced. I've also never seen her in a "happy" manic state.
If I watch her closely, ask her how her mood swings are, and work with her therapist & pdoc, (seen weekly) I should know if mood stabilizers are called for or not.
Taylor really only wants the zoloft, and if I show her that I'm willing to let her try it and see how she feels, she may be more willing to try a mood stabilizer if it isn't working for her. (at this point, I'd taper off the 50mg seroquel she's taking)
Thank you!
Laura
Posted by Lou Pilder on June 24, 2013, at 11:26:30
In reply to correction- Lou's response, zoloft,remeron,suicide, posted by Lou Pilder on June 23, 2013, at 14:59:03
> > > > > Hello,
> > > > >
> > > > > This is my first post, so I hope I'm in the right area of the forum. My daughter (13) HAS MDD, and is complaining of mood swings. She was hospitalized as she was consumed with thoughts of suicide 70% of the time. She was given ZOLOFT 100mg, and SEROQUEL (has been on up to 300 mg - but is now down to 50mg) The drop in SEROQUEL made her mood swings severe, and she was cutting more than ever. At higher levels of Seroquel, she'd walk into walls, and not fully wake-up until afternoon. She seems stabilized at 50mg, but is still having some mood swings, not sleeping well, and the suicidal thoughts remain at 10%. (which is remarkable, as she's only been on meds for about 3 mos.)
> > > > >
> > > > > Her pdoc just switched her from SEROQUEL to REMERON (along with the 100mg zoloft) I'm a little nervous about this combo from what I've read.
> > > > >
> > > > > If anyone can shed any light on this combination, and what it might do for her??... i.e. is remeron better than seroquel for MDD with mood swings, insomnia, etc.. She says she doesn't have anxiety, but the pdoc maintains that her depression has been the worst she's seen in her medical career.
> > > > >
> > > > > After that information, the doc really didn't answer my questions, but told me to use what I wanted - the seroquel or the remeron. (if remeron wasn't tolerated, switch back to seroquel) I'm really confused; ANY help is appreciated!!
> > > > >
> > > > > (note that I don't know the dosage of the Remeron yet as my husband took my daughter to the pdoc and I haven't picked it up yet)
> > > > >
> > > > > Thanks!
> > > >
> > > > laurah,
> > > > You wrote,[...could anyone shed any light...ANY help is appreciated...].
> > > > If you continue with what you are doing to your child, she could be dead today or tomorrow or maybe some day after that. You see, the chemicals that you are drugging your daughter with, in collaboration with a psychiatrist, have the potential to cause death via what is known as serotonin syndrome, as one way those drugs could kill her. But it is much more than that. I am prevented from posting here what IMHHHO could save your daughter's life, prevent life-ruining conditions or addiction due to prohibitions posted to me here by Mr Hsiung. So I am prevented from shedding the light that IMHHHO could heal your daughter. You could go to the administrative board here and review post by me and see years of outstanding requests/notifications from me to Mr Hsiung and his deputy now and his past deputies. I think that by you doing that, you could have your psychiatrist email me and I could advise him/her and then he/she could relay that to you.
> > > > As to the suicide thoughts that you posted here about your daughter, be advised that the drugs that she is given can INCREASE suicidal thinking. And also, when taking these drugs together, the adverse effects are increased exponentially.
> > > > So can she have a way out? I know of a way out, but if you stop the drugs she could go into a mind-altered state to be compelled to kill herself or others, even commit mass-murder.
> > > > Lou
> > > >
> > >
> > > Laurah,
> > > If you could show the following statistics to you psychiatrist, he/she could then answer your questions and if the psychiatrist will not give you a straight answer, what could that tell you?
> > > You see, giving these drugs to a 13 year old is (redacted by respondent) and I would really like for this doctor that is giving you daughter these drugs to post here so that I can post my response to him/her.
> > > Lou
> > > http://www.ehealthme.com/ds/zoloft/death
> > > http://www.ehealthme.com/ds/remeron/death
> >
> > laurah,
> > Your mention of suicide thoughts here by your daughter is something that I need to warn you about. You see, taking these drugs together increases suicidal thinking.
> > Lou
> > http://www.ehealthme.com/zoloft-and-remeron/suicide+attempt
>
> correction:
> http://www.ehealthme.com/zoloft-and-remeron/suicide-attemptFriends,
If you are a parent and following this discussion, be advised that last year it is generally accepted that 42,000 deaths were attributed to psychiatric drugs. I think that number is under the real number of deaths. A lot of the deaths are of children. There are many reasons for that.
What could be unbeknownst to you is the history of psychiatric drugging that I am prevented from posting here due to the prohibitions posted to me by Mf. Hsiung. I think that if you were allowed to know these facts, that lives could be saved, life-ruining conditions and addictions could be avoided. There are many other facts that I am prohibited to post here also. What this means to you is that you could be led to a false conclusion because facts are not allowed to be posted here by me that if they were known by you, you could IMHHHHO make a more-informed decision as to drug your child or not in collaboration with a psychiatrist/doctor /prescriber.
Here is an article that I would like discussants here to read and there is a video also.
Lou
To see this article:
A. Pull up google
B. Type in, [New documentary: Psychiatric Drugs can kill you child]
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