Posted by sleepy lizard on October 20, 2002, at 22:54:45
In reply to From Paxil to Remeron...not working out. =(, posted by Janel C. on October 20, 2002, at 21:29:19
Sorry that Remeron doesn't work for you. I have had a similar experience with Paxil, which worked well for my anxiety/depression, but gave intolerable sexual side effects. I tried out other medications after that but was unable to get rid of the side effects. (Celexa, Effexor XR, Wellbutrin SR). The problem with the sexual side effects seems to be that all of the current antidepressants that work well on both depression and anxiety, also work on the serotonin (5ht2) uptake pump, possibly causing anorgasmia, etc. A possible solution is to increase dopamine since dopamine enhances sexual activities. Now, Paroxetine has no effect on dopamine but has higher serotonergic activity and also increases prolactin (which inhibits sexual interest and performance too). Some of the other medications do increase dopamine slightly, and this may explain some side effect differences. Wellbutrin is one of those, but it may increase anxiety too. It seems that most of the medications have a stimulant effect increase anxiety but help with depression, and those that increase serotonin have an anti-anxiety effect but give sexual side effects. Most doctors work down a list of medications starting with SSRI's then Effexor, then Remeron, Serzone. After that maybe TCA's or MAOI's but they don't like the older drugs because of the drug interactions and they also have side effects like the SSRI's too. And finally, some doctors will add another mediction to the main one to try to eliminate the side effect. My psychiatrist said the remedies for sexual side effects don't work in his experience and he recommended drug holidays of two days. The this is that may help the anorgasmia, but not the libido. For women, believe it or not, Viagra seems to help, as a remedy. In general the remedies work better for women than for men. Some try Wellbutrin added to the other drug. It might work for you, but Remeron is a light duty drug for some people and Paxil is very strong. I had the worst withdrawal side effects from Paxil and Effexor buy the way. If you are just getting off of Paxil and a month has not passed yet, you may be depressed due to that. The Remeron may not be strong enough to compensate. It takes 2 weeks to a month for Remeron to get up to speed. I hope some of this helps.
poster:sleepy lizard
thread:124445
URL: http://www.dr-bob.org/babble/20021019/msgs/124462.html