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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Prefect on March 18, 2018, at 18:26:58
I'm on 150 mg zoloft and 0.5 mg Clonazepam daily. Last night I took 3.75 mg Remeron (mirtazapine) to see if it'll help me sleep. Not only did it not do that, I've had brain zaps all day. How can that happen? Such a low dose. What would be the mechanism behind it?
Posted by linkadge on March 20, 2018, at 16:44:04
In reply to Remeron Brain Zaps?!, posted by Prefect on March 18, 2018, at 18:26:58
Hi Prefect,
You may actually try a lower dose...
My theory on brain zaps (which can happen during SSRI withdrawal) is because of an enhancement of norepinephrine signaling.
By blocking serotonin receptors and alpha-2 receptors, you can get an enhancement of norepinephrine. If the SSRI has supressed norepinephrine for a while, then mirtazapine can reverse this (causing brain zaps).
I would encourage you to try a lower dose (as low as 1mg).
You might also try taking it earlier in the evening (say 6-7pm). Some studies show that sedating antidperessants work better for sleep if taken earlier.
Linkadge
Posted by Prefect on March 20, 2018, at 19:51:15
In reply to Re: Remeron Brain Zaps?! » Prefect, posted by linkadge on March 20, 2018, at 16:44:04
Thanks Linkadge,
I was hoping to actually use mirtazapine for its therapeutic value (california rocket fuel it with my day time zoloft) so in fact was planning to raise the dose.
I'm in serious trouble right now because I have autonomic activation from anxiety of the extreme that people with PTSD have (I'm convinced I have HPA axis dysfunction), and I noticed alcohol is the only thing that calms it down. Well, over the past few months using it as a med and a sleep aid, I've basically become an alcoholic in the sense that I actually get alcohol withdrawal symptoms during the day.
I was hoping to use mirtazapine as both sleep aid and its therapeutic effect, or something to replace alcohol with.
Posted by Prefect on March 20, 2018, at 20:41:11
In reply to Re: Remeron Brain Zaps?! » Prefect, posted by linkadge on March 20, 2018, at 16:44:04
I should add, the 0.5 mg Clonazepam and 10 mg Propranolol I take during the day is not making a dent in my daytime alcohol withdrawal symptoms. I shake and feel feverish all day till 5-6 pm when I allow myself to start drinking again, and I practically become symptom free. No idea how to get out of this...
Posted by SLS on March 21, 2018, at 10:48:26
In reply to Re: Remeron Brain Zaps?! » Prefect, posted by linkadge on March 20, 2018, at 16:44:04
> Hi Prefect,
>
> You may actually try a lower dose...
>
> My theory on brain zaps (which can happen during SSRI withdrawal) is because of an enhancement of norepinephrine signaling.
>
> By blocking serotonin receptors and alpha-2 receptors, you can get an enhancement of norepinephrine. If the SSRI has supressed norepinephrine for a while, then mirtazapine can reverse this (causing brain zaps).
>
> I would encourage you to try a lower dose (as low as 1mg).
>
> You might also try taking it earlier in the evening (say 6-7pm). Some studies show that sedating antidperessants work better for sleep if taken earlier.
Hi Linkadge.Your theory looks very good to me.
How might oxcarbazepine (Trileptal) affect SSRI withdrawal? I theorized a long time ago that this drug might help mitigate the withdrawal syndromes of SSRI, SNRI, benzodiazepine, and possibly alcohol.
- Scott
-----------------------------------
Posted by SLS on March 21, 2018, at 11:09:55
In reply to Re: Remeron Brain Zaps?!, posted by Prefect on March 20, 2018, at 19:51:15
You might want to try prazosin, a NE-1a/b/d receptor antagonist. It treats PTSD and the depression and anxiety that accompany it. I am having success with it at 20 mg/day. You don't necessarily need to have classic PTSD in order for prazosin to work. A history of childhood adversity (chronic abuse and neglect) can produce C-PTSD (complex PTSD).
Alternatively, you can try propranalol, a NE beta antagonist, to reduce sympathetic activation. I don't know for certain that you can combine prazosin and propranalol together. Hypotension would be an issue. I'm guessing yes, though. Coreg (carvedilol) is a dual-action drug that combines NE beta blockade and NE alpha-1a blockade. It is used often for heart failure. If you are going to try prazosin, you must initiate treatment with a single 1 mg dose immediately before going to bed, or else dizziness and syncope can result. You can then begin to titrate the dosage upwards. You can take 2-3 mg on day 2 and go from there. Be sure to dose 2-3 times a day. Prazosin has a short half life. The only side effect I experience is a diminution of sex-drive. It is a pretty big compromise to make, but I don't have a better choice at the moment.
- Scott
Posted by Prefect on March 23, 2018, at 11:06:31
In reply to Re: Remeron Brain Zaps?! » Prefect, posted by SLS on March 21, 2018, at 11:09:55
Hi Scott,
Just got my doc to prescribe prazosin. Do you take it at bedtime, is it sedating?
Posted by SLS on March 28, 2018, at 13:05:51
In reply to Re: Remeron Brain Zaps?!, posted by Prefect on March 23, 2018, at 11:06:31
> Hi Scott,
>
> Just got my doc to prescribe prazosin. Do you take it at bedtime, is it sedating?Hi.
Sorry to take so long to answer you.
Most doctors will prescribe prazosin 3.0 mg at bedtime only for PTSD. If nightmares are what is being treated, this is appropriate. However, some doctors are going up to 45 mg/day given in three divided doses to treat both depression and anxiety all day long. Again, this is usually prescribed with people who have PTSD. My doctor uses it on me because it is likely that I have developmental PTSD / complex PTSD / chronic trauma disorder. This is the result of childhood adversity - whether it be from physical or emotional abuse or neglect.
https://www.ncbi.nlm.nih.gov/pubmed/24490030
Prazosin does not sedate me or help me sleep. It doesn't hurt, though.
- Scott
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