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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 38. This is the beginning of the thread.
Posted by Scars R. Stories on March 31, 2013, at 8:14:14
In reply to anhedonia possibly induced by remeron, posted by Stone on November 1, 2009, at 20:31:57
Hi there -
I've been in the same situation. A few things:
Effexor (XR) and Wellbutrin are the ONLY antidepressants that have been proven to work in long-term studies. The original studies on antidepressants of SSRI/SNRI classes (Remeron has been removed from the SNRI category) were only 8-12 weeks long. Ultimately, more thorough research has demonstrated that SSRIs and Remeron act only as well as placebos.
Remeron acts MUCH MORE like an antipsychotic. I don't know how much you know about antipsychotic action, but it's nearly identical. This leads me to believe it is dopamine depletion primarily (also serotonin, because of the Effexor XR withdrawal factor). Thus, you may want to go on Wellbutrin. You may also want to go back on Effexor XR. It's a good drug. The withdrawal is horrible. However, after 10 years of treatment, I got off the Effexor and took 30mg Remeron. I ended up experiencing the worst depression of my life, and by the end of the year attempted suicide for the first time in about 5 years (I used to be a frequent flyer) and ended up in the hospital.
My psychiatrist is in his late 70s and is a medication expert. Immediately, when I was still being admitted, he came to see me and immediately restarted Effexor XR.
I take 450 mg Effexor XR. I have a very fast metabolism.
All Best,
scars
Posted by Tomatheus on March 31, 2013, at 9:41:47
In reply to Re: anhedonia possibly induced by remeron, posted by Scars R. Stories on March 31, 2013, at 8:14:14
> Effexor (XR) and Wellbutrin are the ONLY antidepressants that have been proven to work in long-term studies.
Actually, findings from Robinson et al. (1991) demonstrated that patients who had been initially responsive to Nardil went on to respond significantly more favorably to two-year treatment with either 45 mg/day or 60 mg/day of the medication than to two-year treatment with placebo.
A link to the study doesn't seem to be available, but I've included reference information below.
Tomatheus
==
REFERENCE
Robinson, D.S., Lerfald, S.C., Bennett, B., Laux, D., Devereaux, E., Kayser, A., et al. (1991). Maintenance therapies in recurrent depression: New findings. Psychopharmacology Bulletin, 27, 31-39.
Posted by Scars R. Stories on March 31, 2013, at 14:03:00
In reply to Long-term antidepressant studies » Scars R. Stories, posted by Tomatheus on March 31, 2013, at 9:41:47
> > Effexor (XR) and Wellbutrin are the ONLY antidepressants that have been proven to work in long-term studies.
>
> Actually, findings from Robinson et al. (1991) demonstrated that patients who had been initially responsive to Nardil went on to respond significantly more favorably to two-year treatment with either 45 mg/day or 60 mg/day of the medication than to two-year treatment with placebo.
>
> A link to the study doesn't seem to be available, but I've included reference information below.
>
> Tomatheus
>
> ==
>
> REFERENCE
>
> Robinson, D.S., Lerfald, S.C., Bennett, B., Laux, D., Devereaux, E., Kayser, A., et al. (1991). Maintenance therapies in recurrent depression: New findings. Psychopharmacology Bulletin, 27, 31-39.
>Excuse me - I meant the only effective antidepressants manufactured during the past 40 years. Yes, I know several people that responded to Parnate as well after Effexor stopped working or failed to work for them.
Posted by linkadge on March 31, 2013, at 18:22:32
In reply to Re: Long-term antidepressant studies, posted by Scars R. Stories on March 31, 2013, at 14:03:00
>Effexor (XR) and Wellbutrin are the ONLY >antidepressants that have been proven to work in >long-term studies.
What the hell are you talking about? Seriously. Why are you hell bent on bashing mirtazapine? There have been other "long term" studies on the ability of fluoxetine, mirtazapine, TCAs and sertraline (probably others) to prevent relapse.
Also, SSRis alone give me bad anorexia. Adding wellbutrin made this worse for me. Remeron gives me great sleep, and helped improve the apathy caused by effexor.
Admit it, high dose effexor + wellbutrin, you might as well be snorting cocaine.
Personally, I think mirtazapine is the bomb! I take about 7.5 mg of mirtazapine with effexor and have done great. I tried higher doses of effexor and I just end up agitated with insomnia. I can't concentrate on high doses of effexor either. Also, long term, it just makes me an apathetic zombie.
I would agree that mirtazapine has some antipsychotic like effects. It does not have direct antidopaminergic action, however. 5-ht2 antagonism can modulate the dopamine system. 5-ht2 antagonists have some antipsychotic like effects.
Longer term, high dose effexor just makes me unstable and paranoid. Effexor greatly supresses rem sleep, which can cause initial euphoria but wicked relapse. I would agree that remeron does not have the same umph as effexor, but in conjunction with other meds, it can help TRD. The combination of effexor and remeron is superior to either agent alone. Infact, remeron + effexor was found superior to parnate for TRD.
Posted by Bob on March 31, 2013, at 22:11:47
In reply to Re: Long-term antidepressant studies, posted by linkadge on March 31, 2013, at 18:22:32
> >Effexor (XR) and Wellbutrin are the ONLY >antidepressants that have been proven to work in >long-term studies.
>
> What the hell are you talking about? Seriously. Why are you hell bent on bashing mirtazapine? There have been other "long term" studies on the ability of fluoxetine, mirtazapine, TCAs and sertraline (probably others) to prevent relapse.
>
> Also, SSRis alone give me bad anorexia. Adding wellbutrin made this worse for me. Remeron gives me great sleep, and helped improve the apathy caused by effexor.
>
> Admit it, high dose effexor + wellbutrin, you might as well be snorting cocaine.
>
> Personally, I think mirtazapine is the bomb! I take about 7.5 mg of mirtazapine with effexor and have done great. I tried higher doses of effexor and I just end up agitated with insomnia. I can't concentrate on high doses of effexor either. Also, long term, it just makes me an apathetic zombie.
>
> I would agree that mirtazapine has some antipsychotic like effects. It does not have direct antidopaminergic action, however. 5-ht2 antagonism can modulate the dopamine system. 5-ht2 antagonists have some antipsychotic like effects.
>
> Longer term, high dose effexor just makes me unstable and paranoid. Effexor greatly supresses rem sleep, which can cause initial euphoria but wicked relapse. I would agree that remeron does not have the same umph as effexor, but in conjunction with other meds, it can help TRD. The combination of effexor and remeron is superior to either agent alone. Infact, remeron + effexor was found superior to parnate for TRD.
>
Linkadge:I was always under the impression that low dose Remeron is extremely sedating and causes significant weight gain. I assume you might not have a problem with the weight part of it since I think I can recall you actually have problems keeping weight on. If I am correct on that part, what about the sedation? Did you have an initial problem and then it wore off, or did you never have a problem?
Bob
Posted by sigismund on April 1, 2013, at 1:08:25
In reply to Re: Long-term antidepressant studies » linkadge, posted by Bob on March 31, 2013, at 22:11:47
>If I am correct on that part, what about the sedation?
The sleep for me was great but the day after was terrible until 3pm.
I might respond well to 5ht2c antagonism.
Posted by Phillipa on April 1, 2013, at 9:25:44
In reply to Re: Long-term antidepressant studies, posted by sigismund on April 1, 2013, at 1:08:25
No two people are alike the month I took 15mg of remeron & that was in combo with benzos I never ever experienced any form of sedation or help with sleep. Hence after a month I just stopped taking it. No withdrawal no nothing. That's my experience only. Phillipa
Posted by SLS on April 1, 2013, at 10:21:39
In reply to Re: Long-term antidepressant studies, posted by sigismund on April 1, 2013, at 1:08:25
> >If I am correct on that part, what about the sedation?
>
> The sleep for me was great but the day after was terrible until 3pm.
>
> I might respond well to 5ht2c antagonism.You could use nortriptyline with Effexor if depression is a problem and use cyproheptadine as a sleep aid.
- Scott
Posted by tensor on April 1, 2013, at 16:19:52
In reply to Re: Long-term antidepressant studies, posted by linkadge on March 31, 2013, at 18:22:32
> Admit it, high dose effexor + wellbutrin, you might as well be snorting cocaine.
Interesting combo, have you tried it?
/tensor
Posted by Scars R. Stories on April 1, 2013, at 17:21:58
In reply to Re: Long-term antidepressant studies, posted by linkadge on March 31, 2013, at 18:22:32
> >Effexor (XR) and Wellbutrin are the ONLY >antidepressants that have been proven to work in >long-term studies.
>
> What the hell are you talking about? Seriously. Why are you hell bent on bashing mirtazapine? There have been other "long term" studies on the ability of fluoxetine, mirtazapine, TCAs and sertraline (probably others) to prevent relapse.
>
> Also, SSRis alone give me bad anorexia. Adding wellbutrin made this worse for me. Remeron gives me great sleep, and helped improve the apathy caused by effexor.
>
> Admit it, high dose effexor + wellbutrin, you might as well be snorting cocaine.
>
> Personally, I think mirtazapine is the bomb! I take about 7.5 mg of mirtazapine with effexor and have done great. I tried higher doses of effexor and I just end up agitated with insomnia. I can't concentrate on high doses of effexor either. Also, long term, it just makes me an apathetic zombie.
>
> I would agree that mirtazapine has some antipsychotic like effects. It does not have direct antidopaminergic action, however. 5-ht2 antagonism can modulate the dopamine system. 5-ht2 antagonists have some antipsychotic like effects.
>
> Longer term, high dose effexor just makes me unstable and paranoid. Effexor greatly supresses rem sleep, which can cause initial euphoria but wicked relapse. I would agree that remeron does not have the same umph as effexor, but in conjunction with other meds, it can help TRD. The combination of effexor and remeron is superior to either agent alone. Infact, remeron + effexor was found superior to parnate for TRD.
>
>
Have you been using cocaine? lolThat is a combination psychiatrists use when they are in the business of saving lives. I never said anything about COMBINING them, though you're going to be disappointed. Most antidepressants in development right now are...
SNDRIs! What must that be like, crack? Especially if you crush your pills up and smoke them? :\ Your comment strikes me as bizarre.
I corrected myself already, I'll do it once more - I meant to say "EFFEXOR AND WELLBUTRIN ARE THE ONLY EFFECTIVE ANTIDEPRESSANTS ***OVER THE PAST 40 YEARS***" ...I'll also fetch the reference. So I did not mean to say anything about TCAs or MAOIs. I stand by my statements about SSRIs and Remeron both lacking any demonstrable therapeutic value in the treatment of depression. Here: Ed Shorter http://www.amazon.com/Before-Prozac-Troubled-Disorders-Psychiatry/dp/0195368746 ....he's quite respected among psy-s.
Fluoxetine has been one of the worst performing SSRIs. Not only does it do nothing for depression, but it's the antidepressant most likely to cause mania/psychosis. And the most likely to cause many other side effects.
Really, do you know anyone who takes PROZAC in this day and age?
Mirtazipine has been proven to be helpful to some with SLEEPING. Hence the counteractiing your "Effexor buzz" bit. Depression? Nope. Not even classified as one in recent psychopharmacological indexes. These books are a little heavy to throw your way, surely you have some of your own?Everyone metabolizes drugs differently. I take a high dose of Effexor because I have an incredibly fast metabolism. I'm sorry. Just call me a cokehead while you're promoting antidepressants that don't work, won't you?
scars
Posted by SLS on April 1, 2013, at 18:45:28
In reply to Re: Long-term antidepressant studies, posted by Scars R. Stories on April 1, 2013, at 17:21:58
Combining Effexor or Pristiq with Wellbutrin works magic for some people being treated for depression. I hope people aren't dissuaded from trying this combination. A friend of mine has achieved full remission using Pristiq 100 mg/day + Wellbutrin 300 mg/day. She had been only partially responsive to Parnate previously. If I hadn't reacted so negatively to Wellbutrin multiple times in the past, I would have tried an Effexor + Wellbutrin years ago. My friend has maintained remission since 2008 without experiencing any breakthrough episodes.
- Scott
Posted by linkadge on April 1, 2013, at 19:27:47
In reply to Re: Long-term antidepressant studies » linkadge, posted by Bob on March 31, 2013, at 22:11:47
I avoid most of the sedation by taking it earlyish (around 7:00 pm). Also its nothing that a good dose of coffee doesn't offset. I don't mind being a bit drowsy in the morning. Its far less impairing for me than waking early (2-4:00am) and not being able to get back to sleep.
Again, remeron is no guarenteed to cause weight gain, just as TCAs are not guarenteed to cause urinary hesitancy. I never had problems with dry mouth or urinary hesitancy on TCAs.
I think its got a lot to do with the initial symptoms of depression. Doctors probably think "oh this is an antidepressant" and just prescribe it without consideration of what types of depression it will help.
Back in the olden days, severe loss of appetite was a hallmark of severe depression. Now, when depression = bad hair day, people can't take a bit of weight gain, so they ditch it.
Linkadge
Posted by linkadge on April 1, 2013, at 19:47:27
In reply to Re: Long-term antidepressant studies, posted by Scars R. Stories on April 1, 2013, at 17:21:58
Look, I don't know what 'studies' you are referring to. Data can be analyzed in a million different ways to reach different conclusions.
Thats why effexor > sertaline > citalopram > effexor
One study sponsored by GSK showed that wellbutrin was excellent for anxiety. That doesn't mean that this is true.
Wellbutrin is a good stimulant like medication for atypical depression. Atypical depression is more common in western cultures due to the general crisis with overconsumption, obesity and insulin resistance. This combined with the typical western focus on workaholsim would naturally produce a market for stimulant like antidepressants. In fact, wellbturin will substitute for cocaine and methamphetamine in certain animal models of stimulant reinforcement.
The type of depression we have today is more a result of our fast paced lifestyles and poor nutrition. Classic depression, was almost always described in terms of insomnia, agitation, anxiety, weight loss etc.
My grandfather had many depressive epsisodes in his life. In his 80's they gave him wellbutrin and it had him pacing nonstop for days and nights in a row. Finally they went back to doxapin (which had worked for him in the past). Doxapin has a similar profile to mirtazapine (high h1 and 5-ht2 antagonism).
Mirtazapine has been shown in a few studies to have a faster onset of activity than SSRIs or SNRIS. But again, 'depression' is an incredibly heterogeneous disorder. I have a friend that responded well to fluoxetine. Also, his seizure frequency dropped (an additional therapeutic effect of fluoxetine) from about 3 a day to 1 a week. AFAIK, epilepsy is not terribly responsive to placebos.
When I am depressed. I don't need an "antidepressant". I need something that will help me sleep and eat, and my body can do the rest to heal itself.
Linkadge
Posted by linkadge on April 1, 2013, at 20:07:36
In reply to Re: Long-term antidepressant studies, posted by linkadge on April 1, 2013, at 19:47:27
Also, most of the new treatments for depression have nothing to do with monoamine reuptake inhibition.
See: http://www.neurotransmitter.net/newdrugs.html
Different antidepressants have different binding profiles. For instance amitriptyline is a potent trk-b agonist, mimicking the effects of brain derived neurotrophic factor. Fluvoxamine is a sigma-1 agonist, mimicking the effects of nerve growth factor NGF.
Posted by linkadge on April 1, 2013, at 20:16:33
In reply to Re: Long-term antidepressant studies, posted by linkadge on April 1, 2013, at 19:47:27
Long term escitalopram:
http://www.ncbi.nlm.nih.gov/pubmed/16754413
Long term mirtazapine:
http://www.ncbi.nlm.nih.gov/pubmed/9669186
Linkadge
Posted by Scars R. Stories on April 2, 2013, at 1:44:03
In reply to Re: Long-term antidepressant studies, posted by linkadge on April 1, 2013, at 20:16:33
> Long term escitalopram:
>
> http://www.ncbi.nlm.nih.gov/pubmed/16754413
>
> Long term mirtazapine:
>
> http://www.ncbi.nlm.nih.gov/pubmed/9669186
>
> Linkadge
>THESE ARE STUDIES FROM 1998? When Remeron was still classified and marketed as an antidepressant? Before they figured out they were wrong about the antidepressant bit but it makes for sleep that's deep as death. Are the past 15 years to be disregarded? I'm a graduate student and I couldn't get away with that in the sociology department! Dude! Point deduction!
Posted by SLS on April 2, 2013, at 9:43:52
In reply to Re: Long-term antidepressant studies » linkadge, posted by Scars R. Stories on April 2, 2013, at 1:44:03
> > Long term escitalopram:
> >
> > http://www.ncbi.nlm.nih.gov/pubmed/16754413
> >
> > Long term mirtazapine:
> >
> > http://www.ncbi.nlm.nih.gov/pubmed/9669186
> >
> > Linkadge
> >
>
> THESE ARE STUDIES FROM 1998? When Remeron was still classified and marketed as an antidepressant? Before they figured out they were wrong about the antidepressant bit but it makes for sleep that's deep as death. Are the past 15 years to be disregarded? I'm a graduate student and I couldn't get away with that in the sociology department! Dude! Point deduction!It is my impression of Remeron that you should suffer a deduction of at least two points if it is your contention that Remeron is devoid of clinically relevant antidepressant properties. If you are unaware that the true effective dosage of Remeron for treating depression is 45 - 90 mg/day, then another three points should be deducted. That's my opinion.
It is my hope that our opinions diverge for observational rather than theoretical reasons.
- Scott
Posted by Scars R. Stories on April 2, 2013, at 11:14:42
In reply to Re: Long-term antidepressant studies » Scars R. Stories, posted by SLS on April 2, 2013, at 9:43:52
> > > Long term escitalopram:
> > >
> > > http://www.ncbi.nlm.nih.gov/pubmed/16754413
> > >
> > > Long term mirtazapine:
> > >
> > > http://www.ncbi.nlm.nih.gov/pubmed/9669186
> > >
> > > Linkadge
> > >
> >
> > THESE ARE STUDIES FROM 1998? When Remeron was still classified and marketed as an antidepressant? Before they figured out they were wrong about the antidepressant bit but it makes for sleep that's deep as death. Are the past 15 years to be disregarded? I'm a graduate student and I couldn't get away with that in the sociology department! Dude! Point deduction!
>
> It is my impression of Remeron that you should suffer a deduction of at least two points if it is your contention that Remeron is devoid of clinically relevant antidepressant properties. If you are unaware that the true effective dosage of Remeron for treating depression is 45 - 90 mg/day, then another three points should be deducted. That's my opinion.
>
> It is my hope that our opinions diverge for observational rather than theoretical reasons.
>
>
> - Scott
>
>Oh, my opinions are based completely on clinical observations - observation about myself and about 10 others. I gained HALF MY BODY WEIGHT (was 120 lbs, became 170) on Remeron. Others gained and could not exercise the weight off, all started craving sweets like mad. ONE person I encountered took 90 mg/night and didn't gain a pound...though she had an eating disorder. And was on so many other meds it would be a puzzle to figure out the sum effect.
The effects of Remeron felt to me very similar to my experience with Clozaril. It's documented effects on cortisol, insulin, and blood lipids, along with its slowing of the metabolism, now documented based on long-term research (observations) and mechanism of action makes me think that the powers that be are very correct in their reclassification of this medication from antidepressant to sleep aid. And I think that medications that cause type II Diabetes should only be used as a last resort, and with much caution.
Two rather respected, experienced psychiatrists that I see have both told me that from their observations over many years, they think it is not an antidepressant, and do not like to prescribe it because of its effect on appetite and weight.
Posted by tensor on April 2, 2013, at 11:28:31
In reply to Re: Long-term antidepressant studies, posted by Scars R. Stories on April 2, 2013, at 11:14:42
> Oh, my opinions are based completely on clinical observations - observation about myself and about 10 others. I gained HALF MY BODY WEIGHT (was 120 lbs, became 170) on Remeron. Others gained and could not exercise the weight off, all started craving sweets like mad. ONE person I encountered took 90 mg/night and didn't gain a pound...though she had an eating disorder. And was on so many other meds it would be a puzzle to figure out the sum effect.
> The effects of Remeron felt to me very similar to my experience with Clozaril. It's documented effects on cortisol, insulin, and blood lipids, along with its slowing of the metabolism, now documented based on long-term research (observations) and mechanism of action makes me think that the powers that be are very correct in their reclassification of this medication from antidepressant to sleep aid. And I think that medications that cause type II Diabetes should only be used as a last resort, and with much caution.
> Two rather respected, experienced psychiatrists that I see have both told me that from their observations over many years, they think it is not an antidepressant, and do not like to prescribe it because of its effect on appetite and weight.I'm sorry to hear Remeron didn't work out for you or your friends, fortunately there many others to try. Remeron has been very helpful to me over the years. I think its efficacy as an antidepressant is well established.
http://www.stacommunications.com/journals/diagnosis/2009/09-sep-09/wnicr09-09.pdf
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2960046-5/abstract
/tensor
Posted by SLS on April 2, 2013, at 12:40:58
In reply to Re: Long-term antidepressant studies » Scars R. Stories, posted by tensor on April 2, 2013, at 11:28:31
Regarding mirtazapine (Remeron):
> I think its efficacy as an antidepressant is well established.
>
> http://www.stacommunications.com/journals/diagnosis/2009/09-sep-09/wnicr09-09.pdf
>
> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2960046-5/abstract
>
> /tensorThanks for the citations. It is interesting that both studies came to the same conclusion - that escitalopram (Lexapro) and sertraline (Zoloft) are the most effective antidepressants when one considers both efficacy and tolerability. I was surprised by how low paroxetine (Paxil) scored
If I were a virgin and wished to avoid MAOIs, I might ask my doctor to:
1. Start with Lexapro
2. Switch from Lexapro to Zoloft
3. Add Wellbutrin
4. Switch from Zolft to Effexor
5. Switch from Wellbutrin to nortriptyline
6. Add Remeron
- Scott
Posted by Phillipa on April 2, 2013, at 18:18:49
In reply to Re: Long-term antidepressant studies, posted by SLS on April 2, 2013, at 12:40:58
Lexapro favored? Interesting thanks. Phillipa
Posted by Phillipa on April 2, 2013, at 18:24:54
In reply to Re: Long-term antidepressant studies » linkadge, posted by Scars R. Stories on April 2, 2013, at 1:44:03
Wiki likes it. Also used in cats interesting.
Posted by linkadge on April 2, 2013, at 19:02:06
In reply to Re: Long-term antidepressant studies » linkadge, posted by Scars R. Stories on April 2, 2013, at 1:44:03
>Before they figured out they were wrong about >the antidepressant bit but it makes for sleep >that's deep as death
Who are "they"?
Posted by linkadge on April 2, 2013, at 19:05:55
In reply to Re: Long-term antidepressant studies » Scars R. Stories, posted by SLS on April 2, 2013, at 9:43:52
Remeron can be an extraordinarily effective antidepressant in individuals who are otherwise unresponsive to monoamine reuptake inhibitors.
I remember a study suggesting that those with the SS (loss of function) version of the serotonin transporter, responded better to mirtazapine than SSRI.
If you have the SS variant of the serotonin transporter gene, your baseline reuptake of serotonin is already low, producing elevated activation of serotonin receptors in the amygdala (hence an elevation of stress response seen in these individuals).
I have found mirtazapine very effective in reducing generalized fear
Posted by linkadge on April 2, 2013, at 19:07:54
In reply to Re: Long-term antidepressant studies, posted by Scars R. Stories on April 2, 2013, at 11:14:42
>Oh, my opinions are based completely on clinical >observations - observation about myself and >about 10 others.
I think (although I could be way off base here) that mirtazapine has been studied in individuals other than yourself and the 10 you have observed.Linkadge
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Dr. Bob is Robert Hsiung, MD,
[email protected]
Script revised: February 4, 2008
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