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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by pretty_paints on August 16, 2004, at 9:45:00
Hello
Iv just been to see my pdoc and she gave me two options:
1 - Add a sedative to my 300mg Efexor
2 - Drop down to 225mg Efexor and add a sedating antidepressant
I have been having massive anger and rage, anxiety and agitation ever since I went up to 300mg. It has helped my depression though. We decided to go for adding another AD. I felt like, although a sedative would be good, it would just calm me down, and still leave my depression with much to be desired. Also, she then suggested (as I hoped she would) that I could try these and then maybe add a sedative if the sedating AD isnt sedating enough (if you see what I mean!).
Anyway, the AD is Zispin (Mirtazapine). I didn't recognise the name, but I'm just looking online and I think its what it more commonly called Remeron. Is this right? (I'm in the UK, so probably just different names).
I don't know much about this drug. I actually had been thinking that remeron was stimulating, but I guess not..? Anyone been on this drug and had success? Or anyone know anything about how it works?? I'm also being treated for OCD so we're hoping the sedative aspect of it will help that. Anyone been on it for that?
Thanks a lot for any info!!
Oh, PS: *CALLING ANY DRUG BUFFS!*
I was also just wondering, just for my general interest really, if anyone could fill something. I know there is all the usual ADs: the SSRIs, tricyclics, MAOIs etc. But I've always seen drugs mentioned on this board (mainly Remeron, Wellbutrin, Ritalin and the like) and never really known what they are. So they are ADs right? But what type? And are they ever used on their own, or do they augment other drugs?
Wow, its actually quite interesting.
Posted by crazychickuk on August 16, 2004, at 10:10:59
In reply to REMERON / ZISPIN, posted by pretty_paints on August 16, 2004, at 9:45:00
Remeron has been known to cause anger ... sometimes just for the first week or 2 and sometimes all the time.. for me it was just for 2 weeks..
give it a go see how you get on..i am surprised that you can take 2 ad's i asked about adding effexor to remeron and i was told no way..
Posted by Sad Panda on August 16, 2004, at 10:40:46
In reply to Re: REMERON / ZISPIN, posted by crazychickuk on August 16, 2004, at 10:10:59
> i am surprised that you can take 2 ad's i asked about adding effexor to remeron and i was told no way..
>
>CC, you need to find a better doctor. :)
Pretty_paints, I took Effexor + Mirtazapine for about 9 months, it's an excellent combo made famous by the Psychopharmacology Doctor Stephen M. Stahl & dubbed Califonia Rocket Fuel. :) Mirtazapine will smooth over the bad effects of Effexor & give you a solid nights sleep. Start at 7.5mg & move up slowly as it is incredibly sedating the first time you take it. It is the most potent antihistamine you can buy. I would try doseages between 7.5mg & 30mg. At higher doseages it can become stimulating, but for alot of people it is an ugly stimulation causing a far bit of crankiness & irritability.
Cheers,
Panda.
Posted by crazychickuk on August 16, 2004, at 10:47:11
In reply to Re: REMERON / ZISPIN, posted by Sad Panda on August 16, 2004, at 10:40:46
Was 3 doctors and my physciatrist who said this to me sad panda....
what you reckon about me going back onto effexor? and ading 10mg inderal if i need it for the racing heart ??? what you think?
Posted by Sad Panda on August 16, 2004, at 11:22:30
In reply to Re: REMERON / ZISPIN-sad panda, posted by crazychickuk on August 16, 2004, at 10:47:11
> Was 3 doctors and my physciatrist who said this to me sad panda....
>
> what you reckon about me going back onto effexor? and ading 10mg inderal if i need it for the racing heart ??? what you think?
>
>Sounds good. Did you get that 5 months worth of Remeron tablets?
Cheers,
Panda.
Posted by TheOutsider on August 16, 2004, at 11:26:01
In reply to Re: REMERON / ZISPIN-sad panda, posted by crazychickuk on August 16, 2004, at 10:47:11
I have some experience with Zispin/Remeron.
I personaly found it difficult to take on a continues basis because it is so sedating. Unfortunatly I tend to oversleep as it is, so Remeron exacerbated the problem!
Other than the sedation it seems to be a good drug. It has a good side effect profile.
It is cerntainly excellent for sleep.
It's also a very effective against anxiety, some people find it as effective as Benzo's.If you don't mind me asking I love to know who your doctor is, they sound very progresive for the UK, and I'm desperate to find a decent doctor.
Posted by crazychickuk on August 16, 2004, at 11:48:24
In reply to Re: REMERON / ZISPIN-sad panda » crazychickuk, posted by Sad Panda on August 16, 2004, at 11:22:30
NO all they could get was 1 mnth ... no point in taking it for just 1 mnth... i will take it to the pharmacist so they can give it to someone who needs it..
Posted by Sad Panda on August 16, 2004, at 12:29:35
In reply to Re: REMERON / ZISPIN-sad panda, posted by crazychickuk on August 16, 2004, at 11:48:24
> NO all they could get was 1 mnth ... no point in taking it for just 1 mnth... i will take it to the pharmacist so they can give it to someone who needs it..
>
>Keep them & use them PRN. When you aren't taking them daily, 15mg of Remeron is like 10mg of Valium.
Cheers,
Panda.
Posted by linkadge on August 16, 2004, at 17:57:53
In reply to Re: REMERON / ZISPIN-sad panda » crazychickuk, posted by Sad Panda on August 16, 2004, at 12:29:35
If you are having "massive" anger on 300mg of effexor then I would seriously warn against the addition of remeron. This combination might send your anger into overdrive. Mirtazapine is an alpha-2 antagonist. Generally when there is too much noradrenaline in the system this receptor gets activated and lowers noradrenic release. By blocking this receptor you are amplifying the noradrenic effect of effexor.
Personally, I would lower the effexor and try adding trazodone or something.
Linkagde
Posted by pretty_paints on August 17, 2004, at 6:47:32
In reply to to pretty paints, posted by linkadge on August 16, 2004, at 17:57:53
Ah right. The only thing is, my pdoc knew all about my anger, it was the main thing we talked about, and she seemed to chose this AD especially to help. I dunno.
Iv gone down to 225mg today and I'm feeling a bit low. Do you think that the advantages of having the two AD's will outweigh the disadvantage of reducing my Efexor dose?
What I mean is, what do you think is more powerful, "300mg Efexor" or "225mg Efexor + 15mg Remeron"?? (in terms of its antidepressant effect)
And is it any good for OCD?
To the outsider: My pdoc is in Bristol, South West. Whereabouts do you live? Did your GP refer you to your pdoc? How come you're not happy with them?
Posted by linkadge on August 17, 2004, at 11:42:29
In reply to REMERON / ZISPIN, posted by pretty_paints on August 17, 2004, at 6:47:32
Personally I would think that:
150mg of effexor and 15mg of Remeron, would have the same noradenic properties as 300mg of effexor.
When you get too much noradrenalin, the alpha-2 autoreceptor is like a feedback loop and inhibits noradrenic release. But if you block that receptor you get much more noradrenaline release coupled with its subsequent reputake inhibition. I don't know for sure but I would be cautious.
Linkadge
Posted by pretty_paints on August 17, 2004, at 11:49:04
In reply to Re: REMERON / ZISPIN, posted by linkadge on August 17, 2004, at 11:42:29
hehe, thanks Linkadge
Um, do you think you could put this this in 'normal mans terms' for me? I quit my BSc (well, POSTPONED shall we say) in January to deal with this stupid depression, and ever since, my brain has been on holiday :) hehe. I think I'm up to handling some of the old neurotransmitter chat today, but the alphas?! eeek, I'm sorry!
Posted by linkadge on August 17, 2004, at 18:02:47
In reply to Re: REMERON / ZISPIN, posted by pretty_paints on August 17, 2004, at 11:49:04
When the house gets too hot, the thermostat shuts off the heater. Likewise when the brain gets too much norepinephrine the alpha-2 receptors shut off norepinephrine release. Remeron blocks the alpha-2 receptors, this is like turning up the thermostat so that the heater shuts off at a higher temperature.
Effexor warms things up via a different route. Effexor causes the hot air to recyle through the house. Effexor is a reputake inhibitor, this is like taking all hot air that is leaving the house and allowing it another pass throug the house.
So when you take effexor and remeron together, things can get really hot, cause you're simultainiously turning up the thermostat and recycling all hot air that leaves the house.I know that may not be any easier to understand :)
Linkadge
Posted by pretty_paints on August 17, 2004, at 18:10:35
In reply to Re: REMERON / ZISPIN, posted by linkadge on August 17, 2004, at 18:02:47
No Linkadge, thats cool, thanks! I will come to you in the future. I like this talk of houses and thermostats and little heaters, much easier to digest during my broken-brain periods.
So Efexor is (kinda) an SSRI yeh? No its a SNRI isn't it, but it basically works in the same way as prozac and the like, but with an effect on noradrenalin as well?
So what class does Remeron come in then? Its not an SSRI is it. Or a TCA. Does it just stand alone as a new drug?
Posted by TheOutsider on August 17, 2004, at 18:50:39
In reply to REMERON / ZISPIN, posted by pretty_paints on August 17, 2004, at 6:47:32
To the outsider: My pdoc is in Bristol, South West. Whereabouts do you live? Did your GP refer you to your pdoc? How come you're not happy with them?
Hi, sorry I couldn't be more helpful on the Remeron issues.
I'll try answering your questions one by one.
Firstly I live in Cambridge UK. Distance is not to much of an issue though, I would travel to Mars to get a decent doctor!
Secondly my GP did indeed refer me to my Pdoc.
I used to have a very decent private doctor, but he has now been forced to retire.Thirdly, why am I not happy with my current Pdoc?
Were shall I begin!?
Actualy I think he's not especially bad for an average UK doc.The thing about the situation that frustrates me is that I always have appointements with a junior Pdoc, who then goes and consults with the senior one.
This is bad because I will have agreed on a treatment with the junior doctor, after an hours consultation. Then the junior doctor will speak to the senior one, he will rubbish my suggestions for treatment and decided on a completely diffirent drug, without even having seen me!RRRR
This wouldn't really matter if I wasn't depressed and anxious. The senior doc prescribed clomipramine for me, which helps with the anxiety, but has nightmare side effects.
The cure is worse than the disease!
Posted by crazychickuk on August 17, 2004, at 20:34:34
In reply to For Pretty Paints, posted by TheOutsider on August 17, 2004, at 18:50:39
I am in wales..... no decent dos here and we only got one physcicatist consultant here...
Posted by pretty_paints on August 18, 2004, at 11:22:42
In reply to Re: For Pretty Paints, posted by crazychickuk on August 17, 2004, at 20:34:34
Oh wow, I feel so comforted to hear people chatting about places I know!! Its weird to think there are actually REAL people going through the same thing as me, d'you know what I mean? Its like, everyone in my life is "normal", and then the people who understand my problems are online in this weird cyberworld! But no, you are actually living in places I know! hehe
Outsider, are you at Cambridge University? If so, which college? I was (well, techincally still am) at Sidney Sussex, until I took time out in Jan. I don't think I'm going to be going out next year yet, mainly as my pdoc wouldn't write me a letter to take to admissions supporting a decision to go bac. Deep down I know I am nowhere near well enough anyway. But another year out feels like a huge step. They have been kind though and are keeping my place open for another year.
Let me know anyway! It would be great to chat.
That sounds like a huge nuisance with the junior pdoc. I would get really frustrated. What are you being treated for mainly?
Posted by TheOutsider on August 18, 2004, at 17:42:24
In reply to Re: For Pretty Paints, posted by pretty_paints on August 18, 2004, at 11:22:42
> Oh wow, I feel so comforted to hear people chatting about places I know!! Its weird to think there are actually REAL people going through the same thing as me, d'you know what I mean? Its like, everyone in my life is "normal", and then the people who understand my problems are online in this weird cyberworld! But no, you are actually living in places I know! hehe
>
> Outsider, are you at Cambridge University? If so, which college? I was (well, techincally still am) at Sidney Sussex, until I took time out in Jan. I don't think I'm going to be going out next year yet, mainly as my pdoc wouldn't write me a letter to take to admissions supporting a decision to go bac. Deep down I know I am nowhere near well enough anyway. But another year out feels like a huge step. They have been kind though and are keeping my place open for another year.
>
> Let me know anyway! It would be great to chat.
>
> That sounds like a huge nuisance with the junior pdoc. I would get really frustrated. What are you being treated for mainly?
>Hi Pretty Paints
Its really good to finaly meet someone who's lived in Cambridge!I completely know what you mean about people who understand existing in a weird cyberworld which isnt quite reality. You hear about what their doing, but it always seems a little unreal especialy if their in America or Australia.
I also feel that every one around me is 'normal' although of course that is a relative term.
So you were at Sidney Sussex? I must have walked past it literaly hundreds of times! Although I don't think I've ever been inside.
I'm not actualy at Cambridge university, my pairents have lived in Cambridge for the last seven years, so I lived in Cambridge for quite a while. I actually graduated from the University of York this Summer.I'm currently being treated for depression and social phobia, although I might quite possibly have a dash of ADHD thrown in for good measure!
What were you reading at Sidney Sussex?
My email adress is tomsky55@hotmail.com
Appologies if spelling and punctuation are a bit wonky, I'm quite dyslexic.
Posted by pretty_paints on August 18, 2004, at 18:08:17
In reply to Re: For Pretty Paints, posted by TheOutsider on August 18, 2004, at 17:42:24
For Outsider: Thanks outsider for your message, I've taken your email and will get back to you at a better moment!
To anyone else, PLEASE HELP, I'm feeling terrible tonight. I just feel painfully sad, and its just unbearable. In some ways its ok, coz at least its a feeling, but it still is agony.
Who knows why. I went down to 225mg from 300mg Efexor yesterday and last night I started taking 15mg Remeron. That knocked me out until 4pm today, and generally I was ok.
But now I am just feeling terrible. Low. And so in pain. I thought that I was dealing with something in therapy quite well, but now I'm thinking that the only reason I was dealing with it "well" was coz I was so angry and psycho on 300mg that I just was able to bear the pain. And now that the 300mg is gone, the pain is suddenly really bad. Oh I'm so unhappy. Why can't things ever be right for us.
I dont know if this is true,or whether I am just generally feeling low as a result of the meds change. At the time the problem always seems so real, and my "explanation" of everything really makes sense, and then afterwards I realise it was just down to the general change.
oh I dunno. I just feel miserable. At least if I take the remeron now then it'll knock me out in about an hour and I can sleep :(
Posted by TheOutsider on August 19, 2004, at 18:23:02
In reply to i feel so terrible, posted by pretty_paints on August 18, 2004, at 18:08:17
> For Outsider: Thanks outsider for your message, I've taken your email and will get back to you at a better moment!
>
> To anyone else, PLEASE HELP, I'm feeling terrible tonight. I just feel painfully sad, and its just unbearable. In some ways its ok, coz at least its a feeling, but it still is agony.
>
> Who knows why. I went down to 225mg from 300mg Efexor yesterday and last night I started taking 15mg Remeron. That knocked me out until 4pm today, and generally I was ok.
>
> But now I am just feeling terrible. Low. And so in pain. I thought that I was dealing with something in therapy quite well, but now I'm thinking that the only reason I was dealing with it "well" was coz I was so angry and psycho on 300mg that I just was able to bear the pain. And now that the 300mg is gone, the pain is suddenly really bad. Oh I'm so unhappy. Why can't things ever be right for us.
>
> I dont know if this is true,or whether I am just generally feeling low as a result of the meds change. At the time the problem always seems so real, and my "explanation" of everything really makes sense, and then afterwards I realise it was just down to the general change.
>
> oh I dunno. I just feel miserable. At least if I take the remeron now then it'll knock me out in about an hour and I can sleep :(Are you feeling any better now?
I wonder if the Remeron is perhaps not right for you?
I found that initialy at least Remeron made me slightly more depressed, because it made me tired and cognitivly slow.As for feeling that things are a certain way, I'd be suspicious of the validity of evaluations made when one is depressed.
This is the end of the thread.
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