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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by mtom on July 10, 2019, at 18:13:26
As mentioned in other posts, I have been cross-tapering Escitalopram (name brand Lexapro/Citalopram) to Mirtazapine (generic Remeron) for about a month, right now taking low doses of both and increasing the Mirtazapine very slowly as I'm hypersensitive to AD side effects (which I had tons of with Escitalopram, more so the higher I went in dose - and I never got to the "standard" dose because of these). Previously Citalopram was even worse, and a long ago try of Zoloft was awful. So decided with my Dr to try something different from SSRI's.
I've had a few "better" days the last couple of weeks, but very inconsistent. E.g. occasional days where I feel better (not 100% or anything, but noticeable) and motivated and energetic enough to spend most of the day tackling and completing difficult and long neglected tasks. But then followed by a couple of days of back to feeling the same as before (or almost the same).
Is response, when it happens, usually steady, or can it be step-wise initially with better and worse days?
Posted by Lamdage22 on July 10, 2019, at 21:05:27
In reply to When AD's work, can it be up and down initially?, posted by mtom on July 10, 2019, at 18:13:26
Did it destabilize you?
Posted by TH on July 10, 2019, at 21:25:50
In reply to When AD's work, can it be up and down initially?, posted by mtom on July 10, 2019, at 18:13:26
It's very much stepwise from what I've read. The analogy is the tide coming in; you can't tell from the individual waves and need to watch for a while to see the change.
Posted by mtom on July 10, 2019, at 22:32:02
In reply to Re: When AD's work, can it be up and down initially?, posted by Lamdage22 on July 10, 2019, at 21:05:27
> Did it destabilize you?
No, it's not like that. I don't feel worse. I just am feeling noticeably a bit better some days, and not so much other days.
It may be more like what TH posted. I guess I have to give it a bit more time and keep increasing the dose in small increments, slowly and gradually, in the hope that I'll hit a dose that has efficacy without huge side effects. So far only notable side effect from Mirtazapine is some nightmares and vivid dreams. But I've gotten those on Escitalopram and other AD's also, especially when titrating dose. They seem to decrease in intensity over time.
Maybe a little groggy in the morning, but not too bad. This is the first AD I've tried that hasn't increased my anxiety (happened even at very low doses with others), in fact I think it may have improved slightly on average. But, per my initial post, things are a bit up and down still.
And still concerned that at some point as I increase dose the NE effect of Mirt will kick in and that might increase the anxiety again.
Posted by Lamdage22 on July 10, 2019, at 22:34:17
In reply to Re: When AD's work, can it be up and down initially? » Lamdage22, posted by mtom on July 10, 2019, at 22:32:02
Oh okay. No weight gain?
Posted by Christ_empowered on July 11, 2019, at 15:13:01
In reply to Re: When AD's work, can it be up and down initially? » Lamdage22, posted by mtom on July 10, 2019, at 22:32:02
hi. my current 'treatment provider,' a most excellent psych nurse practitioner, explained it to me this way...
when an antidepressant starts taking effect, your feelings/emotions don't improve as rapidly as, say, agitation and sleep disturbances. and so...
sometimes, even in the absence of akathisia, exacerbated depression, etc., there's a not so awesome phase in which the worst of the depressive symptoms have improved/are improving...
but other aspects are still troublesome. this is why, back when the tricyclics were popular, it was common for patients to be provided with 1- or 2-week prescriptions for a time...
there was a 'danger zone,' a period in which drug treatment was taking effect, but the suicide risk was increased a bit, because of activation, etc. tca drugs, of course, are lethal in OD. :-(
i don't know if this applies to you. i just thought it was kind of fascinating, when the nurse practitioner talked to me about it.
i hope you feel better, soon. :-)
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