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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Janel C. on October 20, 2002, at 21:29:19
I have been taking Paxil for over a year and they worked great for me until my decreased sex-dive was interfering with my relationship so my doctor switched me to Remeron in August. I started off with 30mg and one month ago my doctor raised my dosage to 45 since the 30's didn't do a thing. I've been on the 45's for a month now and nothing has improved. The only thing Remeron helps me to do is sleep better, but other than that it feels like I'm not taking any anti-depressants at all since I am having my old symptoms back (i.e. anxiety, depression). I'm going to see my doctor again in two weeks, but until then I'm at a point where I don't know what to do anymore. When I tell my doctor Remeron isn't working out I know she's going to try another drug. However, I'm sick of switching back and forth so should I go back to Paxils or stick to Remeron and hope it will improve my condition? Any feedback would be greatly appreciated. =)
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.
Posted by wcfrench on October 21, 2002, at 2:08:24
In reply to From Paxil to Remeron...not working out. =(, posted by Janel C. on October 20, 2002, at 21:29:19
I noticed very little improvement on Remeron. What improvement I did notice took a long time to be apparent, over a month. But now, I am also having a lack of response to my new medicine, so it could just be treatment resistance. I can tell you this: once you stop it, you won't sleep very well. That's why I'm up. Good luck.
-Charlie
Posted by Janel C. on October 21, 2002, at 14:41:36
In reply to Re: From Paxil to Remeron...not working out. =(, posted by wcfrench on October 21, 2002, at 2:08:24
> I noticed very little improvement on Remeron. What improvement I did notice took a long time to be apparent, over a month. But now, I am also having a lack of response to my new medicine, so it could just be treatment resistance. I can tell you this: once you stop it, you won't sleep very well. That's why I'm up. Good luck.
>
> -Charlie
Thank you sleepy lizard, that was a very informative response. And thanks Charlie. I had the worse Paxil withdrawl as well, the week I was decreasing my dose was hell, I was lightheaded and felt dizzy. But so far I have been taking Remeron for about six weeks now and there hasn't been any improvement at all. Like sleepy lizard has pointed out though, since Remeron is not as strong as Paxil perhaps that's why it's taking longer to take effect, who knows. And I agree Charlie, if I stop taking Remeron I will definitely have trouble sleeping again afterwards, no doubt about it. Well I suppose all I can do for now is maybe wait and hope Remeron will start taking effect soon b/c I'm a college student and right now it's really affecting my studies as I don't have any motivation nor can I concentrate. When I was on Paxil it was the opposite, I was very motivated through college and concentrated a lot better. In a way I'd like to go back on Paxil because of that, but at the same time I know how hard is it to get out of it if I ever decide to stop taking it again.
Posted by tai on October 21, 2002, at 22:47:21
In reply to From Paxil to Remeron...not working out. =(, posted by Janel C. on October 20, 2002, at 21:29:19
I too came off a medication because of the sexual difficulties it was causing me. I was on zoloft and doing the best I had ever been in my life but was getting frustrated because it does tinker with your libido. So I dropped it cold turkey one day when I had just had enough of it. That was over the summer. Since then I have been trying out some different meds that could possibly get me back to where I was minus the sexual aspect. It has been a long and difficult road with no success for either so far.
At this point, I really wish I had just stayed on the zoloft. Looking back, if I had known the downward spiral that would follow I would have made a different decision. I now realize that I can accept so-so sex in place of good mental health.
My advice would be to stay with what works.
This is the end of the thread.
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