Posted by SLS on July 26, 2012, at 14:16:07
In reply to Re: any experience dose greater than 45mg of Remeron? » mogger, posted by novelagent on July 26, 2012, at 13:22:11
> I'm surprised you're higher than 30mg-- there's a certain dose where these meds don't do much more, it's a case of diminishing returns. You can try augmenting it with an antipsychotic, or maybe try switching to emsam if you need relief of depression (especially atypical depression) but I really don't see the benefit of going more than 45mg-- in my opinion, you're on too high of a dose as it is.
Some people don't respond to Remeron until they reach dosages of 60 mg/day and higher. I don't think Remeron is given an adequate trial unless one reaches at least 45 mg/day. The NIH used 60 mg/day as their maximum dosage during their STAR*D study. Remeron is probably underutilized by doctors because it is always underdosed, yielding disappointing results.
http://www.ncbi.nlm.nih.gov/pubmed/16816220
This is the titration protocol they used:
"Recommended mirtazapine doses were 15 mg/day for the first 7 days, 30 mg/day by day 8, 45 mg/day by day 28, and, if necessary, 60 mg/day by day 42."
http://ajp.psychiatryonline.org/article.aspx?Volume=163&page=1161&journalID=13
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