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Dr. Bob is Robert Hsiung, MD,
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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
Posted by linkadge on April 2, 2013, at 19:10:21
In reply to Re: Long-term antidepressant studies » Scars R. Stories, posted by tensor on April 2, 2013, at 11:28:31
The cumulative probabilities of being among the four most efficacious treatments were: mir- tazpine (24.4%), escitalopram (23.7%), venlafaxine (22.3%), and sertraline (20.3%)
(from the link by tensor)
Posted by sigismund on April 2, 2013, at 19:15:39
In reply to Re: Long-term antidepressant studies, posted by linkadge on April 2, 2013, at 19:05:55
>I have found mirtazapine very effective in reducing generalized fear
Link, how long had you been on it before you felt that?
Posted by Scars R. Stories on April 2, 2013, at 19:21:59
In reply to Re: Long-term antidepressant studies » Scars R. Stories, posted by tensor on April 2, 2013, at 11:28:31
> > 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
>
> /tensorI'm not talking about my "friends". I'm talking about people that I've encountered while working at an inpatient psychiatric facility. What would cause you to think I'm speaking of friends? Is that supposed to be some kind of passive aggressive slight about my clinical expertise? That would be silly.
WHY DO PEOPLE HERE NOT KNOW WHAT LEGITIMATE ACADEMIC, MEDICAL RESEARCH IS?
Posted by Scars R. Stories on April 2, 2013, at 19:27:31
In reply to Re: Long-term antidepressant studies, posted by linkadge on April 2, 2013, at 19:02:06
> >Before they figured out they were wrong about >the antidepressant bit but it makes for sleep >that's deep as death
>
> Who are "they"?"They" are the group of individuals that work for pharmaceutical companies that use their great scientific expertise to do all the can for human wellness by creating new medicines, and doing things out of the goodness of their hearts. Wow. Like funding universities and giving people discounts on medications they can't afford ;)
Posted by Scars R. Stories on April 2, 2013, at 19:29:52
In reply to Re: Long-term antidepressant studies, posted by linkadge on April 2, 2013, at 19:05:55
> 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 fearInteresting! How is SS tested for?
Re: fear, I would have to say again, "because it is sedating", like benzodiazepines but with a host of unpleasant side effects.
Posted by Scars R. Stories on April 2, 2013, at 19:52:51
In reply to Re: Long-term antidepressant studies » linkadge, posted by sigismund on April 2, 2013, at 19:15:39
> >I have found mirtazapine very effective in reducing generalized fear
>
> Link, how long had you been on it before you felt that?
>
>
Let me take a guess if I may - within the first few days? Because of its sedating qualities and consequent reduction of fear responses like sensitivity to loud noise and panic?Why wouldn't you just take Xanax or one of the other many minor tranquilizers that are almost devoid of side-effects, certainly not anything like causing Diabetes!
Posted by SLS on April 2, 2013, at 20:40:09
In reply to Re: Long-term antidepressant studies )) tensor, posted by Scars R. Stories on April 2, 2013, at 19:21:59
> WHY DO PEOPLE HERE NOT KNOW WHAT LEGITIMATE ACADEMIC, MEDICAL RESEARCH IS?
Please do NOT be so quick to generalize to everyone here the extent of the knowledge and understanding they possess. Even if every single person here disagrees with you does not mean that their conclusions are not the product of informed and thoughtful deliberation.
- Scott
Posted by Phillipa on April 2, 2013, at 21:17:11
In reply to Re: Long-term antidepressant studies, posted by Scars R. Stories on April 2, 2013, at 19:52:51
One month on 15mg nothing stopped it and no withdrawal. Continued on low dose of benzos. Medicaire recently started paying for them. Due to so many docs prescribing atypical antipsychotics and the elderly falling and yes things like diabetes. So now benzos are now back in. Never in over 44 years gained an ounce. Body mass index done yesterday at endos puts me at 22.5 for 5.41/2 foot female. Perfect BMI. And with excercise a lot is muscle. Phillipa
Posted by Emme_V2 on April 2, 2013, at 23:50:45
In reply to Re: Long-term antidepressant studies )) tensor, posted by Scars R. Stories on April 2, 2013, at 19:21:59
> > > 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
>
> I'm not talking about my "friends". I'm talking about people that I've encountered while working at an inpatient psychiatric facility. What would cause you to think I'm speaking of friends? Is that supposed to be some kind of passive aggressive slight about my clinical expertise? That would be silly.
>
> WHY DO PEOPLE HERE NOT KNOW WHAT LEGITIMATE ACADEMIC, MEDICAL RESEARCH IS?
I detected no passive-aggressiveness in tensor's post. The 10 others sounds like a small enough number that they might have been friends or acquaintances you encountered over some period of time in a setting as a patient or in a support group. Your post didn't particularly suggest a research setting per se, just a clinical one.There have been a number of folks here with training in the sciences, including medical as well as other fields. Instead of yelling, why not tell us a little bit about whatever study you worked in? I'm sure it would be interesting - people here tend to be fairly curious and like to hear about what the research community is doing.
BTW, Remeron was a very effective AD for me. I had to stop it for a short time, however, and when I restarted, it didn't work again. But it was good for a while. The weight gain was a down side though.
emme
Posted by SLS on April 3, 2013, at 8:35:10
In reply to Re: Long-term antidepressant studies )) tensor » Scars R. Stories, posted by Emme_V2 on April 2, 2013, at 23:50:45
> I'm not talking about my "friends". I'm talking about people that I've encountered while working at an inpatient psychiatric facility.
There is an important place for anecdotal observation, especially in a field of medicine that still relies on empirical evidence. I would not negate your submissions here as invalid. I was able to observe a rather large population of folks with mental illness while I was at a partial hospitalization program for mental illness and substance abuser / addiction (MICAA) for 8 years. I would guess that I witnessed the outcomes of various pharmacological and psychotherapeutic treatment modalities of over 150 people treated there.
I didn't see Remeron used very often. That doesn't surprise me, though. Understandably, the medical staff followed the guidelines for treatment protocols as described in the drug manufacturer's label or PDR. Unfortunately, this means using dosages of Remeron not exceeding 30 mg/day. That's like prescribing dosages of Prozac not to exceed 5.0 mg/day. From what I have read, and my observation of others, the true effective dosage range for using Remeron to treat severe depression is actually 45 - 90 mg/day. It is at these higher dosages that pro-noradrenergic effects emerge. For whatever reason, higher dosages of Remeron are generally less sedating than lower dosages. I don't know if the propensity for weight gain differs at higher dosages.
- Scott
Posted by SLS on April 3, 2013, at 8:36:53
In reply to Re: Long-term antidepressant studies » linkadge, posted by Scars R. Stories on April 2, 2013, at 19:29:52
Sorry.
- Scott
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Dr. Bob is Robert Hsiung, MD,
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