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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by maryhelen on April 9, 2003, at 14:49:05
Hi everyone! I am new to this board although I have been reading it for over a year. I have always been so impressed with the intelligence, wit, knowledge, support and caring that I have seen. I do feel a little intimidated to post.
I have been on so many medications and combinations over the last 20 years that I can't remember them all. I have treatment resistant depression. I am currently on Parnate 80 mg and lithium 600 mg. I am not getting the response that I have heard so many others speak about. Is settling for being less depressed than I used to be to still struggling to get through every day, good enough?
My question is this - prior to Parnate, a little over a year ago, I was taking Remeron. I do know I had an initial response but very quickly gained 60 pounds so I stopped taking it with the understanding from my pdoc that Parnate would give me an excellent response. Ironically, I still have the 60 pounds on despite every attempt to lose it. It is just 'stuck' on me. I would like to try the Remeron again but I have heard that it is not very successful when you re-introduce a drug. Do you know if this is true? Also, if I was to go back on it do you think I would gain more weight?
Any input on this would be appreciated.
Thank you,
Maryhelen
Posted by Ron Hill on April 10, 2003, at 9:47:55
In reply to MEDICATION BLUES, posted by maryhelen on April 9, 2003, at 14:49:05
Hi MaryHelen
Welcome! Glad you decided to post. I don't have experience with Remeron, but someone will come along to provide input.
I just wanted to welcome you to the neighborhood. Did you get your fruit basket on your way in? It's really nice that Dr. Bob provides these welcoming gifts particularly since he pays for them out of his own pocket.
-- Ron
Posted by jrbecker on April 11, 2003, at 12:35:43
In reply to Re: Remeron Questions » maryhelen, posted by Ron Hill on April 10, 2003, at 9:47:55
Mary Helen:
in terms of the tolerance effect or other-wise colloquialized "poop-out" effect, some do report less effectiveness when re-initiating a medication for a second time. Whether this is due to a tolerance build-up to the drug's effect is uncertain. However, I do believe that this effect is overestimated and that most people do respond efficaciously to the same drug if it was successful the first time around.
I don't think this should discrouage you from trying remeron again. Remeron is a fabulous drug for those who are refractory with the SSRIs. In many ways, it acts completely opposite to their effects. Most people I know that are on it have found a comfortable dosage window where they report less sedation than when on an SSRI. My doc even reports some cases where people have experienced less weight gain on remeron than when on an SSRI. It's all individual differences. Don't get me wrong, parnate is a great drug, but a lot more cumbersome b/c of it side effects. If you were having some success with remeron, I would definitely suggest a re-trial of it and try to push the dosage up as high as you can. And maybe down the line, you can look to adjunct with something else to start to figure out a weight loss plan. I can probably add a few suggestions to that as well. Good luck.
JB
Posted by maryhelen on April 11, 2003, at 18:38:56
In reply to Re: Remeron Questions » maryhelen, posted by Ron Hill on April 10, 2003, at 9:47:55
Hi Ron!
Thank you for your welcome message. It was the first message I have received and I appreciate it. I did not know Dr. Bob was so generous. I look forward to getting my fruit basket!!!
Have a great day,
maryhelen
Posted by maryhelen on April 11, 2003, at 19:01:48
In reply to Re: Remeron Questions, posted by jrbecker on April 11, 2003, at 12:35:43
jrbecker:
Thank you sharing with me your knowledge about Remeron. I do feel that I would rather make a change that stay with the Parnate and Lithium. Whether my pdoc agrees or not I will have to see. He usually does because he knows I put a lot of thought and get as much information as I can. I am so disappointed in the Parnate. I know how effective MAOI's are for so many people. I know what works for one doesn't necessarily work for another, but I have tried so many drugs I just wonder if I am going to be depressed like this for the rest of my life.
I am very interested in your suggestions about weight loss. It doesn't make me feel any better having an extra 60 lbs. on.
Thanks again,
maryhelen.
Posted by McPac on April 11, 2003, at 22:47:06
In reply to Re: Remeron Question » jrbecker, posted by maryhelen on April 11, 2003, at 19:01:48
My advice would be to start taking 3 grams of fish oil a day. Keep taking it. Give it time to eventually work.
Posted by jrbecker on April 12, 2003, at 12:09:09
In reply to Re: Remeron Question » jrbecker, posted by maryhelen on April 11, 2003, at 19:01:48
Mary Helen:
good luck with the switch. In terms of suggestions for augmentation for weight loss, well it's really too early to consider it your first priority when your mood is not stable yet. I would only suggest that you explore the following options only after being stabilized on the remeron for at least a month. I'm assuming your BP II since you take the lithium? If that's the case, are you going to stick with it when you switch or was is just an adjunct to the MAOI? If you are sticking with a mood stabilizer, maybe consider something that might not cause as much water retention (e.g., Lamictal). Also, have you ever tried Wellbutrin, and if so, how did you react? It can be a great adjunct for weight loss for some people. Along the same lines, Strattera at low doses might be an option. However, these drugs can induce mania/hypomania/irritability in most BPs so be advised. You might also try a low dose (e.g., 5 mg) of Lexapro at night to counterbalance the weightgain. It acts completely opposite to Remeron at the 5HT2c site, which is part of the culprit for the weight gain. On the bad side, it might also dampen the antidepressant effect of the remeron a little. Supplements to try chromium piconlinate, NADH, fish oil, b-vitamins/zinc. You might try DHEA but this comes with a very big caution since it can interact with the aplha-2 adrenergic effect and make you very overstimulated, so start very small (e.g., 2 mg per day). Maybe try a little tyrosine in the morning and/or at lunch. You might want to consider buying Mind Boosters by Ray Sahelian for other tips. Biggest tip, which is the most obvious of course, exercise, preferably in the late afternoon. This will help keep your food cravings down in the evening and keep your body's metabolism up through the rest of the day. Eat smaller meals throughout the day. Try to eat more protein, but don't skimp entirely on carbs (Atkins spells evil for depressives) it is the worst thing people like us can do to our bodies.
Try to stick to a meditteranean diet...fish, light meats, olive oil, lots of vegetables, less refined grains (but don't cut it out completely), low dairy, low re meat, etc.I am traveling to Alaska on business for a week, so I'll be out of touch with the board, but let me know how you're doing once you've made the switch. Good luck.
JB
Posted by maryhelen on April 12, 2003, at 13:20:28
In reply to MEDICATION BLUES, posted by maryhelen on April 9, 2003, at 14:49:05
Thanks again for your response.
I am not BP II. I have treatment resistant depression. I am hoping to come off the Lithium. I am feeling that it is the Lithium that is causing these additional problems for me. Hand tremors and twitching, hair loss, but most of all a feeling of being 'dim'. My brain is not responsding to a lot of things the way it used to. Even to type takes about 10 times longer than it should (and I have been a school secretary for 30 years). In fact, I am supposed to be returning to work after being off for 2 years and I don't think it will go over big.
I have discussed these symptoms with my pdoc also telling him that I am getting stupid. He doesn't agree that the Lithium could be causing these problems but it's fairly new to me whereas the Parnate is not. I have been on it for over a year with none of these side effect happening.
You have given me a lot of information and I have printed it out. Again, it is taking a little longer for me than usual to let things sink in.
It sounds interesting to go to Alaska. I hope you enjoy even though it is a business trip.
Take care,
maryhelen
Posted by Katia on April 14, 2003, at 14:31:36
In reply to Re: Remeron Questions, posted by maryhelen on April 11, 2003, at 18:38:56
What fruit basket? I never got one....:-(
katia> Hi Ron!
>
> Thank you for your welcome message. It was the first message I have received and I appreciate it. I did not know Dr. Bob was so generous. I look forward to getting my fruit basket!!!
>
> Have a great day,
>
> maryhelen
Posted by joebob on July 17, 2003, at 17:38:47
In reply to Re: Remeron Question, posted by jrbecker on April 12, 2003, at 12:09:09
jrbecker........you are one of the best posters i have seen on this site
here is one of my early posts that you may have missed....> my doc gave me depakote for 2 weeks prior to starting lexapro next week..........
> i am wondering how much dep i might need and will i need to keep taking it after the lex kicks in?by the way my neurologist has a great rep, but doens't do any diagnosis per se, just agrees with what i ask her for and writes it.....scary
i got the pre-dosing suggestion from a npsych who attended a seminar by daniel amen
i did have some mania a few days after trying lexapro the first time and quit
i need to gain weight, my appetite is zero for some time now, i mostly smoke cigs and drink beer
please keep up the good work, it is a help to me and i am sure many others
> Mary Helen:
>
> good luck with the switch. In terms of suggestions for augmentation for weight loss, well it's really too early to consider it your first priority when your mood is not stable yet. I would only suggest that you explore the following options only after being stabilized on the remeron for at least a month. I'm assuming your BP II since you take the lithium? If that's the case, are you going to stick with it when you switch or was is just an adjunct to the MAOI? If you are sticking with a mood stabilizer, maybe consider something that might not cause as much water retention (e.g., Lamictal). Also, have you ever tried Wellbutrin, and if so, how did you react? It can be a great adjunct for weight loss for some people. Along the same lines, Strattera at low doses might be an option. However, these drugs can induce mania/hypomania/irritability in most BPs so be advised. You might also try a low dose (e.g., 5 mg) of Lexapro at night to counterbalance the weightgain. It acts completely opposite to Remeron at the 5HT2c site, which is part of the culprit for the weight gain. On the bad side, it might also dampen the antidepressant effect of the remeron a little. Supplements to try chromium piconlinate, NADH, fish oil, b-vitamins/zinc. You might try DHEA but this comes with a very big caution since it can interact with the aplha-2 adrenergic effect and make you very overstimulated, so start very small (e.g., 2 mg per day). Maybe try a little tyrosine in the morning and/or at lunch. You might want to consider buying Mind Boosters by Ray Sahelian for other tips. Biggest tip, which is the most obvious of course, exercise, preferably in the late afternoon. This will help keep your food cravings down in the evening and keep your body's metabolism up through the rest of the day. Eat smaller meals throughout the day. Try to eat more protein, but don't skimp entirely on carbs (Atkins spells evil for depressives) it is the worst thing people like us can do to our bodies.
> Try to stick to a meditteranean diet...fish, light meats, olive oil, lots of vegetables, less refined grains (but don't cut it out completely), low dairy, low re meat, etc.
>
> I am traveling to Alaska on business for a week, so I'll be out of touch with the board, but let me know how you're doing once you've made the switch. Good luck.
>
> JB
>
>
>
>
This is the end of the thread.
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