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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Denise1966 on June 28, 2005, at 9:58:20
Hi Scott,
Hope you're still feeling well. Can I just ask you what sort of side affects you were getting from the meds? The only side affects for me have been either numbness or anxiety. I'm now taking Seroxat 40mg and mirtazapine 15m and although my mood is quite good I feel completely numb and devoid of any emotions which isn't quite what I had in mind.
I know some of the drugs have affected my appetite but that's not been a problem really.
Kind Regards.......Denise
Posted by ed_uk on June 28, 2005, at 10:16:13
In reply to To Mr Scott - More questions for you, posted by Denise1966 on June 28, 2005, at 9:58:20
Hi Denise,
Now you're on mirtazapine, perhaps you could reduce the paroxetine..........maybe in a few weeks time. You might want to increase mirtazapine to 30mg and decrease the paroxetine to 10-20mg. Paroxetine is often very numbing - especially at high doses.
~Ed
Posted by SLS on June 28, 2005, at 11:18:58
In reply to Re: To Mr Scott - More questions for you » Denise1966, posted by ed_uk on June 28, 2005, at 10:16:13
> Hi Denise,
>
> Now you're on mirtazapine, perhaps you could reduce the paroxetine..........maybe in a few weeks time. You might want to increase mirtazapine to 30mg and decrease the paroxetine to 10-20mg. Paroxetine is often very numbing - especially at high doses.
>
> ~EdI don't know how relevant this is, but Paxil greatly increases one of the active metabolites of Remeron (8-hydroxymirtazepine) because Paxil is a potent inhibitor of CYP450 2D6. I don't think this is much of a problem if one titrates Remeron clinically. It probably is a good idea to reduce the Paxil to 20mg unless it has already shown greater efficacy at the higher dosages. I wouldn't worry about the Remeron metabolite thing. You probably won't realize much benefit from Remeron for depression until you reach a dosage of 45mg. Just remember that you might feel odd upon the introduction of any new drug or upon dosage increases. This is not always such a bad thing. It might mean that things are "cooking".
Good luck.
- Scott
Posted by ed_uk on June 28, 2005, at 11:58:45
In reply to Re: To Mr Scott - More questions for you, posted by SLS on June 28, 2005, at 11:18:58
Hi Scott,
I just found this............it's quite reassuring..........
Hum Psychopharmacol. 2001 Aug;16(6):449-459.
Mirtazapine and paroxetine: a drug-drug interaction study in healthy subjects.
Ruwe FJ, Smulders RA, Kleijn HJ, Hartmans HL, Sitsen JM.
Clinical Development Department, NV Organon, PO Box 20, 5340 BH Oss, The Netherlands.
Paroxetine inhibits cytochrome P(450) 2D6, which is involved in the metabolism of mirtazapine. The possible drug-drug interaction between two pharmacologically distinct antidepressants, mirtazapine and paroxetine, has been investigated in a randomized, three-way crossover study in 24 healthy male and female subjects. After a titration phase of 3 days, each subject received single daily doses of 30 mg mirtazapine, 40 mg paroxetine or the combination for 6 days. Assessments included serial blood sampling for pharmacokinetics at steady state, cognitive testing using the test battery of CDR Ltd, a visual analogue mood rating scale (Bond and Lader) and the Leeds Sleep Evaluation Questionnaire. Paroxetine inhibits the metabolism of mirtazapine, as shown by increases of approximately 17% and 25% of the 24 h AUC's of mirtazapine and its demethyl metabolite, respectively. Mirtazapine did not alter the pharmacokinetics of paroxetine. The combined administration of mirtazapine and paroxetine probably does not alter cognitive functioning or result in major changes on the visual analogue mood rating scale and Sleep Evaluation Questionnaire, compared with the administration of either drug alone. The incidence of adverse events was lower during combined administration of mirtazapine and paroxetine than during administration of either drug alone. Fatigue, dizziness, headache, nausea, anxiety and somnolence were the most common adverse events during combined administration. These data suggest that the combination of mirtazapine and paroxetine is unlikely to lead to clinically relevant drug-drug interactions and can be used without dose adjustment of either drug. The combination may even be better tolerated than either drug alone.
~Ed
Posted by SLS on June 28, 2005, at 13:54:55
In reply to Re: To Mr Scott - More questions for you » SLS, posted by ed_uk on June 28, 2005, at 11:58:45
> Fatigue, dizziness, headache, nausea, anxiety and somnolence were the most common adverse events during combined administration
> The combination may even be better tolerated than either drug alone.
This might reflect the increase in 8-hydroxymirtazepine brought about by Paxil coadministration. This effect is similar to what happens when one increases the dosage of Remeron from 30mg to 45mg. Many of the side-effects that occur at the lower dosages begin to disappear, presumbably as the proportion of NE alpha-2 blockade increases. Just a guess.
- Scott
Posted by ed_uk on June 28, 2005, at 14:24:45
In reply to Re: To Mr Scott - More questions for you » ed_uk, posted by SLS on June 28, 2005, at 13:54:55
Hi Scott,
..........and I suppose Remeron reduces some of Paxil's side effects by blocking serotonin receptors.
Kind regards
~ed
Posted by SLS on June 28, 2005, at 16:26:10
In reply to Re: To Mr Scott - More questions for you » SLS, posted by ed_uk on June 28, 2005, at 14:24:45
> ..........and I suppose Remeron reduces some of Paxil's side effects by blocking serotonin receptors.
I didn't think of that.
:-)
- Scott
Posted by Mr.Scott on June 29, 2005, at 23:38:42
In reply to To Mr Scott - More questions for you, posted by Denise1966 on June 28, 2005, at 9:58:20
Hi!
Well we're all different even though the drug companies would like us and the docs to think otherwise, so take my experience as simply that. The SSRI's made me speedy at first and then over the years I developed muscle stiffness/rigidity, emotional flatness, apathy, doubled cholesterol on zoloft as well as a 35lb weight gain. It didn't do so much for my depression as it might have for my anxiety. Essentially I developed EPS or parkinsonian symptoms from them in addition to many of the more common side effects. I also had constipation where many suffer the opposite effect. I am not typical in my response and one doctor thinks I may be a poor metabolizer of them. Whatever the case, they didn't work for me very well except Prozac initially.
Feel free to ask away...I just saw your post as I have been coming around less often and mostly for the thread follow-ups in my email. Now I'll be sure to get back to you more promptly.
Scott
Posted by Mr.Scott on June 29, 2005, at 23:48:57
In reply to To Mr Scott - More questions for you, posted by Denise1966 on June 28, 2005, at 9:58:20
Sorry I just re-read your post and see you said medications in general not just ssris.
I have to be careful with clonazepam as more than .25mg TID can lead to a feeling like depression. Lithium and lamictal were intolerable. Lamictal put me to sleep at 25mg and had no other effect. Lithium reduced my sexual potency. Neurontin and Depakote tend to make me swell a bit even at low doses, and also make me see more head hair in the shower. That said i could probably deal with those two, and do occassionally use neurontin for sleep. Believe it or not Neurontin also seems to constipate me. Effexor made me anxious and agitated as did cymbalta. Atypicals made me feel like a zombie...and anything else either didn't work or I'd have to look it up. Oh...Remeron made me so hungry and tired I couldn't wait it out because I had to work and all the coffee in the world only added anxiety.
As SLS pointed out...give yourself time to adjust.
I currently take the following regimen with few complaints except insomnia. My depression and anxiety are virtually gone. I am still intense and mildy obsessive, but have come to accept these as character traits that are even good!
Adderall XR 40mg daily
Clonazepam .25mg TID
Right Unilateral ECT once a month.Scott
Posted by Denise1966 on June 30, 2005, at 9:48:27
In reply to Re: To Mr Scott - More questions for you » Denise1966, posted by Mr.Scott on June 29, 2005, at 23:48:57
Hi Mr Scott,
Thanks for getting back to me, both on this thread and the one concerning ECT and it's affects on Speech.
The feelings you described on taking SSRIs are pretty much the ones I'm experiencing now, muscle stiffness/rigidity, emotional flatness, apathy etc, actually the numbness istn't just emotional it's like a physical feeling of numbness as well which is hard to describe, like my breathing muscles are numb. Although I've not had any anxiety recently. The fustrating thing is with this there doesn't seem to be anything I can do to change the way I feel, I tried playing tennis the other day with a friend but it only helped a little not enough to make a difference. I also tried swimming and playing board games but all the time I just feel as though I'm going through the motions.
Lamical and lithium did absolutely nothing for me, the only drug that I can count on to actually make me feel any good (touch wood)(and that's if taken with an SSRI is Zyprexa 10mg.
Anyway, I know you and the other Scott (SLS) said you have to give yourself time to adjust but to be quite honest I'm sick of trying to give these meds time to take affect. It's been 4 long years, 2 of which felt bearable and I actually started to feel like I was enjoying life. Feel's like the Party's over now though.
Anyway, I know the seroxat and this addition of Remeron is not helping me enough, so it's time to do a drug switch for a while and try out ECT.
I was thinking perhaps that the reason that the Seroxat seemed to start helping two years ago was maybe because I'd taken Nardil for a month prior to taking it. I was hoping that Nardil maybe did something to my brain (even though I didn't like being on it) to help me respond to the Seroxat. Maybe that's just wishful thinking though.
Trouble is the psychiatrist who said she was willing to put me forward for ECT has gone off sick so I have to wait for her to come back to work and don't want to have to wait for much longer.
I've just been made redudant and I think everyone here at work is suprised at how well I've taken it, what they don't realise though is that I don't really care. All I care about is this horrible depression and how to get rid of it once and for all.
I'm not worried about having ECT as I really don't know what to expect from it but I am worried that it won't help. I tried rTMS last year and it didn't help me at all.
Anyway, thanks again for responding, if I do have a course of ECT I'll let you know how I get on.
Kind Regards.......Denise
Posted by 4WD on June 30, 2005, at 22:34:51
In reply to Re: To Mr Scott, posted by Denise1966 on June 30, 2005, at 9:48:27
>
I was hoping that Nardil maybe did something to my brain (even though I didn't like being on it)Denise,
I have been considering trying Nardil. Would you mind telling me why you didn't like being on it?
Marsha
Posted by Denise1966 on July 1, 2005, at 12:05:48
In reply to Re: To Mr Scott » Denise1966, posted by 4WD on June 30, 2005, at 22:34:51
Hi Marsha,
I didn't get any anxiety on Nardil but I felt really wierd on it, very little motivation or focus. For instance I went on a long drive to see a friend and hardly remembered anything about the drive afterwards.
It was like I was doing things without actually having any experience of doing them, if that makes sense. Mindyou I only gave it a month on the low initial dose.
But strangely the seroxat which hadn't worked seem to work when I tried taking it again aftr I'd finished on the Nardil.
Kind Regards......Denise
Posted by Denise1966 on July 1, 2005, at 12:06:53
In reply to Re: To Mr Scott » Denise1966, posted by 4WD on June 30, 2005, at 22:34:51
If so what was your reaction to it?
Kind Regards.......Denise
Posted by 4WD on July 1, 2005, at 21:34:54
In reply to Re: To Marsha, posted by Denise1966 on July 1, 2005, at 12:05:48
> Hi Marsha,
>
> I didn't get any anxiety on Nardil but I felt really wierd on it, very little motivation or focus. For instance I went on a long drive to see a friend and hardly remembered anything about the drive afterwards.
>
> It was like I was doing things without actually having any experience of doing them, if that makes sense. Mindyou I only gave it a month on the low initial dose.
>
> But strangely the seroxat which hadn't worked seem to work when I tried taking it again aftr I'd finished on the Nardil.
>
>
>
> Kind Regards......DeniseThanks, Denise. Are you considering trying Nardil followed by Seroxat again? I guess it's the only way to find out if it was an effect.
You said you didn't have anxiety on Nardil. Did you have anxiety before you started it?
I guess the main things that worry me about Nardil are the weight gain/increased appetite and I'm terrifed of the washout period. I've heard, though, that if Nardil works, it works great so I'm willing to give it a go if it come to that. Right now I"m still feeling pretty good (due, I think to having taken about 4mg of Zyprexa a couple of days ago.)
Did you experience weight gain or increased appetite on nardil?
Marsha
Posted by Mr.Scott on July 2, 2005, at 1:25:20
In reply to Re: Scott did you ever try an MAOI?, posted by Denise1966 on July 1, 2005, at 12:06:53
Hi!Nardil was temporarily great much like Prozac was but even better. Then it pooped.
Parnate was like a dirty stimulant for me, and moclobemide was agitation/anxiety in a pill.
Scott
Posted by Mr.Scott on July 2, 2005, at 1:38:07
In reply to Re: To Mr Scott, posted by Denise1966 on June 30, 2005, at 9:48:27
Hi Denise,
If there is anything I can do, questions I can answer, or support I can give, do not hesitate to ask.
Sincerely,
Scott
Posted by Denise1966 on July 4, 2005, at 11:19:03
In reply to Re: To Mr Scott » Denise1966, posted by Mr.Scott on July 2, 2005, at 1:38:07
.
This is the end of the thread.
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