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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by g_g_g_unit on December 27, 2007, at 21:54:23
i suffer from pure-o and have been on remeron for 3 weeks now, 15mg for first two weeks then 30. at 15 i was incredibly hungry and irritable, and so raised to 30 against my pdoc's advice. now i am more alert but am feeling horribly suicidal as well. what's unclear is whether these feelings are being exacerbated by pending circumstances (family is away, pdoc on holiday). 15mg was basically untenable, and now i'm wondering whether it's worth pushing through on 30. i know they say give these things like 6 weeks, but if i;m feeling no relief whatsoever is there a chance it might still kick in, cos i could swear i felt better before going on remeron
Posted by yxibow on December 28, 2007, at 1:44:23
In reply to Remeron - suicide?, posted by g_g_g_unit on December 27, 2007, at 21:54:23
> i suffer from pure-o and have been on remeron for 3 weeks now, 15mg for first two weeks then 30. at 15 i was incredibly hungry and irritable, and so raised to 30 against my pdoc's advice. now i am more alert but am feeling horribly suicidal as well. what's unclear is whether these feelings are being exacerbated by pending circumstances (family is away, pdoc on holiday). 15mg was basically untenable, and now i'm wondering whether it's worth pushing through on 30. i know they say give these things like 6 weeks, but if i;m feeling no relief whatsoever is there a chance it might still kick in, cos i could swear i felt better before going on remeron
You may be feeling a reaction to the NE in Remeron.... Normally Remeron is a very sleepy agent but when I took it the second time around after about a week it ceased to become a sleeping pill and became an antidepressant, except not a pleasant one. I rocked myself to sleep with songs to get around this, this worked for a few more weeks, we raised it a little more, that didn't do a thing. All together, a hideous experience that just raised my heart rate. I suffer from pure O along with other things. I can't say that this is a pure comparison, only you know, but I was just offering an example.
Posted by johnj on December 28, 2007, at 8:38:44
In reply to Remeron - suicide?, posted by g_g_g_unit on December 27, 2007, at 21:54:23
I have been on remeron twice. I have anxiety/ocd(pure O). Remeron made my ocd worse. I didn't quite know it at the time because I hadn't been properly diagnosed but it made me very combatative and there were times I would wake up and just lay there thinking I would like to die. I slept better as that was a big problem but I was always angry. It made me get stuck on things and it was hard to let them go. I would started day dreaming a lot. It made me feel outside of my body. It is hard to explain but I don't think it is any good for ocd. I was mainly on 15 mg but did push it to 30 mg but that was not good as it made me very spacey and out of it.
I can't take ssri's as they cause way too much anxiety. Benzo's are not for me either. I was on them for 10 years and they made me depressed and killed my REM sleep. Right now, I am on nothing and my ocd comes and goes. The anxiety is better but I still have problems but meds didn't help me very much. I have looked into Lyrica or Depakote if I have to go back on something.
I stayed on remeron for 6 months last spring and summer hoping it would even out. It never did and it caused a lot of chest and stomach tension that has finally abated after 5 months of being off it. In a nutshell, it is not good for ocd, IMHO.
Have you tried anafranil? Do you metabolize meds slow or fast? As my pdoc and I have talked about low doses of anafranil at about 25 mg as that has helped some people. I metabolize slow so large doses create too many side effects to allow me to continue. What else have you tried as remeron for ocd is kind of a stretch.
regards,johnj
Posted by johnj on December 28, 2007, at 8:41:19
In reply to Re: Remeron - suicide? » g_g_g_unit, posted by yxibow on December 28, 2007, at 1:44:23
Yes, I forgot about the heart rate. Remeron really caused me problems that I figured was just part of my illness but turned out to be caused by remeron.
What do you take for your pure O right now? My waxes and wanes and I would love to know if any type of CBT worked for you too. Thank you.
johnj
Posted by ace on December 28, 2007, at 20:53:17
In reply to Remeron - suicide?, posted by g_g_g_unit on December 27, 2007, at 21:54:23
> i suffer from pure-o and have been on remeron for 3 weeks now, 15mg for first two weeks then 30. at 15 i was incredibly hungry and irritable, and so raised to 30 against my pdoc's advice.
Just briefly...I would not use this as a first-line medication against the Pure 'O' OCD.
I am unsure we have talked before...have you tried many other meds?It is generally better to follow a MD's advice. However, when it comes to psychiatrists, I feel ambivalent about this....
now i am more alert but am feeling horribly suicidal as well.STOP. REDUCE DOSE IMMEDIATELY.
what's unclear is whether these feelings are being exacerbated by pending circumstances (family is away, pdoc on holiday).
So many variables. The fact is you find a correllation between escalating the dose and suicidal feelings. This is more than enough to warrant lowering the dose (for the time-being)
15mg was basically untenable, and now i'm wondering whether it's worth pushing through on 30.I would advice to 'push through' as least as possible. Forcing, stretching, pushing.....all this is not conducive to mental health I feel...
i know they say give these things like 6 weeks, but if i;m feeling no relief whatsoever is there a chance it might still kick in, cos i could swear i felt better before going on remeronYes! Sometimes an initial bad reaction predicts a good response! I would definately give it 6 weeks. But also I wouldn't allow yourself to suffer too much from possible s/effects.
I hope this helps:)
Ace
Posted by bleauberry on December 28, 2007, at 21:17:44
In reply to Remeron - suicide?, posted by g_g_g_unit on December 27, 2007, at 21:54:23
Sounds like either too much noradrenaline going on, or else blocking those serotonin receptors is not good for you.
Two schools of thought...stick it out and give it time; stop the offending medication. Personally I stop a drug that is offending me that much. People don't just sometimes feel suicidal on a particular drug, they find their family staring at them in a coffin at the funeral home.
The school of thought that says to stick with it argues that as brain changes are ocurring it will be uncomfortable but that good times are on the other side after those changes have happened, and that if you don't stick it out you'll never know. Well, me, I have to work, support a family, appear normal as best I can, and absolutely cannot afford to get worse on a medication. Thus I do not attend the stick it out school. For me I can tell you within 7 days whether a drug is going to be good for me or not. After that it is just a matter of side effects. I did in the past do the stick it out thing. Drugs that made me worse in the first 7 days, still had me worse 2 months later. Drugs that showed some improvement within 7 days were doing pretty good 2 months later.
Posted by bleauberry on January 2, 2008, at 18:36:13
In reply to Remeron - suicide?, posted by g_g_g_unit on December 27, 2007, at 21:54:23
Below is some data that suggests with some strength that if you have not experienced improvement within 2 weeks on remeron the odds of it turning good later are not in your favor.
Szegedi A, Muller MJ, Anghelescu I, Klawe C, Kohnen R, Benkert O.
Early improvement under mirtazapine and paroxetine predicts later stable response and remission with high sensitivity in patients with major depression.
J Clin Psychiatry. 2003 Apr;64(4):413-20.
"OBJECTIVE: Current clinical knowledge holds that antidepressants have a delayed onset of efficacy. However, the delayed onset hypothesis has been questioned recently by survival analytical approaches. We aimed to test whether early improvement under antidepressant treatment is a clinically useful predictor of later stable response and remission. METHOD: We analyzed data from a randomized double-blind controlled trial with mirtazapine and paroxetine in patients with major depression (DSM-IV). Improvement was defined as a 17-item Hamilton Rating Scale for Depression (HAM-D-17) score reduction of > or = 20%. Stable response was defined as > or = 50% HAM-D-17 score reduction at week 4 and week 6, and stable remission as a HAM-D-17 score of < or = 7 at week 4 and week 6. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS: Improvement occurred in a majority of the analyzed patients within 2 weeks (mirtazapine: 72.7% of 109 patients; paroxetine: 64.9% of 103 patients). Early improvement was a highly sensitive predictor of later stable response or stable remission for both drugs. NPV approached maximum values as early as week 2 for mirtazapine and week 3 for paroxetine. After 2 weeks of treatment with mirtazapine and 3 weeks with paroxetine, almost none of the patients who had not yet improved became a stable responder or stable remitter in the later course. CONCLUSION: Our results strongly suggest that early improvement predicts later stable response with high sensitivity. These empirically derived data question the delayed onset hypothesis for both antidepressants tested and provide important clinical clues for an individually tailored antidepressant treatment." [Abstract]Benkert O, Muller M, Szegedi A.
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