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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Stone on November 1, 2009, at 20:31:57
Around 5 months ago my pdoc switched me from Effexor XR 75mg and put me on Remeron 15mg for anxiety and depression because I wasn't handling the effects of Effexor too well. This is where the problem starts.
The problem is I was put down to 37.5mg non-XR version for 3days and then told to start taking Remeron 15mg. Upon doing this I faced extremely horrendous withdrawals, electric like shocks from head to toe throughout my body, vertigo like symptoms and general fatigue and nausea. When I started taking the Remeron I experienced extreme depression and irritablity that I never experienced so extreme before - I have been on 5 anti-depressants in the past and never had felt like this. I had suicidal feelings and thoughts and everything was generally bad. However it did calm down and all of a sudden I noticed that I was feeling emotionally flat in both my depression and anxiety which I thought was quite abrupt and strange.
Curiously I decided over the next few days to test my emotional responses, to music, usual anxiety provoking situations, all different things etc. In this experimentation I found I was feeling what I can only describe as totally emotionally numb. Something I had never experienced before - because even while depressed in the past I do still experience emotions - if only negative ones. So upon realising this and actually being frustrated by my lack of emotions and generally not enjoying anything I decided I had enough and I wanted to take call it quits on Remeron and just take a break from it all. I asked my pdoc if I needed to taper as I was only on it 2 weeks and I told no.
I stopped taking Remeron straight away as instructed and over the next few weeks I started to feel a little irritable again but more or less the same. Then before I knew it was now a month off Remeron and I still feel like I'm on Remeron. So I just decide to wait it out. Then it's 3 months and I still feel the same and I start taking L-tyrosine and doing exercise to try and see if I can get myself back to normal. Now it's 5 months later and I still feel like I'm on Remeron. I have a total numbness and lack of pleasure I have never had before in my life that seems to have permanently stayed since going from Effexor to Remeron and then quitting.
I'm totally frustrated by all of this because I am not experiencing and pleasures or my normal emotions in my life and I just generally hate everything about this because I don't feel like 'me' anymore. I've tried stimulation from caffeine and it has no effect on me at all. I've tried getting drunk but all I experience is the physical impairments and no pleasure. It's a total nightmare.
Now, I don't know if it was the switch from Effexor to Remeron and the tapering between that caused this or Remeron itself or all of the above but I do know that Remeron antagonizes 5-HT2a, 5-HT2c and 5-HT3. I'm guessing that this antagonistic action has left a permanent effect somehow. I read somewhere on this site someone else experiencing anhedonia from being on and coming off Prozac and funnily enough Prozac is an antogonist of 5-HT2c as well.
I'm wondering what people's thoughts are on this matter and I might want to 'try' with my pdoc to get myself on the road to feeling more normal again. My pdoc is at a total loss for what is going on. I've thought about going on an anti-depressant to see how I might feel but I'm a bit reluctant to jump right in as I want to do this right and not scew things up further.
Is it overload of serotonin?
Is it serotonin depletion?
Is it dopamine depletion?I don't know.
Posted by metafunj on November 1, 2009, at 23:47:24
In reply to anhedonia possibly induced by remeron, posted by Stone on November 1, 2009, at 20:31:57
If you read about someone experiencing that with prozac there is a good chance it may have been me. I tried to avoid drugs completely after that experience of losing part of myself. Only after 6 years of getting worse and experiencing less and less emotions did I consider trying drugs again. For me I believe its a dopamine problem. Ironically I was considering Remeron for the problem.
Antagonizing the receptors you mentioned should increase hedonia not decrease it. However coming off SSRIs can cause anhedonia. Its possible this was a delayed reaction after tapering effexor and just started noticing it while on Remeron. Perhaps your body got used to the strength of effexor on norepinephrine and dopamine and Remeron isn't boosting them enough. 15mgs really isn't even a dose that would touch depression or anxiety, but would just make one sleepy. I have a friend who takes it for really bad depression and he takes 45mgs.
Personally I'm very tired of all this. I don't wanna have to try every SSRI, SNRI, what have you before I find something that works. I'm really gonna push to try to get a prodopaminergic drug, but my doc is reluctant to prescribe.Its ashame what these meds can do. I wouldn't even be trying another one if I hadn't discovered that for me, exercise, diet, meditation, chinese medicine, etc does nothing for anhedonia or my cognition. Its like a lobotomy with chemicals.
How long were you taking effexor and was it helping at all?
Posted by Stone on November 2, 2009, at 3:27:49
In reply to Re: anhedonia possibly induced by remeron » Stone, posted by metafunj on November 1, 2009, at 23:47:24
I was on Effexor XR 75mg for around 4 months, and while on it I just had too many side-effects, so it at the time I needed to try something else.
I don't think at 75mg there was any norepinephrine and dopamine effect since those effects usually don't start happening until around 150 - 375mg. I also never really experienced anhedonia on Effexor before.
All I know is that when I started Remeron I had a bad reaction the first time I took the one pill. While on it I just felt like there was a dark cloud hanging over me all the time and I felt extremely tired and out of it. Fast foward to now and nothing has changed, I still feel like I'm on Remeron.
I can only think in both our cases we had a strange reaction. Mine was to Remeron and yours was to Prozac. I can only think for each of us we turn to the medications each of us were on to try and fix the problem - you on Remermon and me on Prozac. However for me, I fear this may not work in my case because their are more areas the antogonistic action was taking place. Whereas with Prozac there is only one, at least that I know of anyway.
Posted by Alexanderfromdenmark on November 2, 2009, at 6:08:06
In reply to anhedonia possibly induced by remeron, posted by Stone on November 1, 2009, at 20:31:57
I'd be blaming the effexor withdrawel if I were you. But then again, you probably know best. Are you gonna wait it out or are you gonna try drugs again?
15 mg remeron can be pretty sedating.
Posted by Stone on November 2, 2009, at 6:53:06
In reply to Re: anhedonia possibly induced by remeron, posted by Alexanderfromdenmark on November 2, 2009, at 6:08:06
Well it could be either Effexor or Remeron but seeing as how the Effexor withdrawal eventually subsided, I don't know...
I don't really know what to do. Right now I feel terrible. If I can be on a med that can fix how I feel then I'm all for it, I mean why not?
15mg is indeed sedating, that's how I feel now. I still feel like I'm on remeron even now I'm off it.
Posted by metafunj on November 2, 2009, at 9:15:38
In reply to Re: anhedonia possibly induced by remeron, posted by Stone on November 2, 2009, at 6:53:06
Yes you very well may have had a reaction to remeron. I guess anything is possible. Remeron antagonizes 3 serotonin receptors, that they know of as well as histamine and the alpha2 adrenic receptor.
You know while I was on prozac the first time I felt great. Coming off was the problem. When I came off I too felt sedated and felt a pressure around my head. For awhile I was taking naps at 2 in the afternoon everyday. I found that ginkgo biloba removed the head pressure and sedation.
I'm sorry to hear that this has happened to someone else. Hopefully you will heal over some time. How are you functioning cognitively?
Posted by Stone on November 2, 2009, at 12:03:28
In reply to Re: anhedonia possibly induced by remeron » Stone, posted by metafunj on November 2, 2009, at 9:15:38
> Yes you very well may have had a reaction to remeron. I guess anything is possible. Remeron antagonizes 3 serotonin receptors, that they know of as well as histamine and the alpha2 adrenic receptor.
>
> You know while I was on prozac the first time I felt great. Coming off was the problem. When I came off I too felt sedated and felt a pressure around my head. For awhile I was taking naps at 2 in the afternoon everyday. I found that ginkgo biloba removed the head pressure and sedation.
>
> I'm sorry to hear that this has happened to someone else. Hopefully you will heal over some time. How are you functioning cognitively?Not so great. It's hard for to even type this, I have revise everything I'm writing over and over because I find whole words missing all the time that I meant to write.
I struggle to do anything at the moment that requires me to think whereas before this all happened it was never a problem. This make me think more and more like it is dopamine related.
Posted by metafunj on November 2, 2009, at 18:41:40
In reply to Re: anhedonia possibly induced by remeron, posted by Stone on November 2, 2009, at 12:03:28
I have the same problem with writing sentences although its not as bad as when I first came off Prozac. In the beginning I'd forget words when speaking. Now I don't do that.
Well welcome to the group. AlexanderfromDenmark, Wanderer123, and I are in the same boat as you. I'm wondering if stimulants could help us?
Posted by g_g_g_unit on November 3, 2009, at 22:41:43
In reply to Re: anhedonia possibly induced by remeron » Stone, posted by metafunj on November 2, 2009, at 18:41:40
you know what's weird: i also had a horribly adverse reaction to Remeron. it was the second med i tried, and at 30mg it made my OCD 1000x times worse. i cold turkeyed off after 2 weeks of hell, told my doc i felt foggy, but he said it was just depression (which i had never really suffered before). i believed him, and continued with trials. what's weird is that a really low dose of Prozac fixed the problem w/ attention, etc. almost immediately, but i couldn't sleep so came off it. i know absolutely nothing about neurochem, but don't both remeron and prozac have some effect on the frontal cortex?
that was about a year ago, and i've been on the bandwagon of SSRI's, MAOI's, etc. since trying to fix a depression which seemed caused by the loss of functioning i felt after Remeron.
i am actually compiling a really detailed history at the moment of every drug i've been on, my exact reactions, etc., so if anyone has some insight into Remeron's actions and what brain area it might have overloaded in me, that will be extremely helpful. and for the record, i too suffered anhedonia after coming off.
Posted by metafunj on November 3, 2009, at 22:52:54
In reply to Re: anhedonia possibly induced by remeron, posted by g_g_g_unit on November 3, 2009, at 22:41:43
The only thing that prozac and remeron share in common to my knowledge is that they are 5 HT2C receptor antagonists. Remeron doesn't block serotonin reuptake, which prozac does. Prozac doesn't antagonizes the 5 HT2A or 5 HT3 receptors or the antihistamine receptor like remeron does.
In the following presentation Dr Stephen Stahl says that 5 HT2C inhibition leads to the release of more dopamine and norepinephrine in the Cortex.
Posted by metafunj on November 3, 2009, at 23:10:58
In reply to Re: anhedonia possibly induced by remeron » g_g_g_unit, posted by metafunj on November 3, 2009, at 22:52:54
http://en.wikipedia.org/wiki/Mirtazapine#Pharmacology
Anhedonia is listed as a side effect.
On second though I may skip this drug and choose one that has euphoria in the side effects list. :)
Posted by g_g_g_unit on November 3, 2009, at 23:51:35
In reply to Re: anhedonia possibly induced by remeron » g_g_g_unit, posted by metafunj on November 3, 2009, at 22:52:54
> In the following presentation Dr Stephen Stahl says that 5 HT2C inhibition leads to the release of more dopamine and norepinephrine in the Cortex.
>
> http://books.google.com/books?id=zqvVZOea2JAC&pg=PA81&lpg=PA81&dq=stephen+stahl+5+ht2c+antagonist&source=bl&ots=nVHy2oiDoB&sig=z9IxNKFQn5KBc-D1V7cEb0w5X-k&hl=en&ei=mAfxSpyXL5XV8Aal-sT2CA&sa=X&oi=book_result&ct=result&resnum=2&ved=0CBgQ6AEwAQ#v=onepage&q=&f=falsemakes sense; even with my completely amateurish understanding, that explains why Prozac would instantly relieve the post-Remeron brain fog. even based on your horror story, i wonder if i should just go back on Prozac. i'll include that Stahl cite in the document i'm preparing.
Posted by metafunj on November 4, 2009, at 9:30:22
In reply to Re: anhedonia possibly induced by remeron, posted by g_g_g_unit on November 3, 2009, at 23:51:35
The horror story wasn't so much being on it. It was coming off it and then it not working when I went back on it.
In fact after a six year break I am taking it now, but at a lower dose to try to avoid the serotonin reuptake inhibiting properties of it. More serotonin just makes me spacey and dizzy.
I'm actually contemplating Remeron myself, if the current mix of Prozac and Buspar doesn't work.
Posted by Economist on March 16, 2010, at 0:00:17
In reply to anhedonia possibly induced by remeron, posted by Stone on November 1, 2009, at 20:31:57
Stone, did this ever get any better? I've been suffering from the exact situation you described for the past three years now.
Posted by Stone on January 11, 2012, at 19:06:52
In reply to Re: anhedonia possibly induced by remeron » Stone, posted by Economist on March 16, 2010, at 0:00:17
In response to the above question, a few years on: I would say the only way I have improved my situation was by accident really. I was prescribed Tramadol for pain, and found 80% improvemet. This has helped me get by, with 1 x 50mg every few weeks to stimulate my brain chemicals, and it seems to normalize things. Taking it everyday induces a typical SSRI haze however, but still an improvement nonetheless - and Tramadol is not something I would want to keep doing on the basis of addiction. If I could, I possibly would, but I don't have that option, which is a shame because it has improved my quality of life.
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