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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Squiggles on July 31, 2003, at 8:51:37
To anyone searching for an effective anti-depressant
for "treatment-resistant" depression, with very
few side effects, we have had great success with
this drug.I am extremely satisfied with the results
for my friend, and once again truly believe that
Dr. Ivan Goldberg's psychopharmacology knowledge
is the cat's pyjamas.There are side effects
- weight gain basically, but
not more, infact less, than the initial
drug given for severe unipolar depression - imipramine.
This drug is the last tried after a series of more
than 16 drugs tried over a period of about 20 years,
each worse than the other, and the best, the first and
the oldest - imipramine.
Does this indicate something about the scientific advances
in newer medication; could be.
Advantages of this drug - eliminates most anxiety
and allows sleep, allows mental clarity and
concentration, stabilizes blood pressure;These advantages, in turn get rid of the
need for secondary drugs to treat the side effects
of the primary drugs (other than this one).
The other drugs had been most new SSRIs and
sisters or imipramine - if anyone is interested
i can get the specific drug names.Lack of sleep is a serious problem with stimulating
ADs, which was a major problem for my friend -
crappy, short sleep. It is hard to live a normal
life without a good night's sleep and harder
still to concentrate.Squiggles
Posted by matthhhh on July 31, 2003, at 10:29:14
In reply to REMERON rocks!, posted by Squiggles on July 31, 2003, at 8:51:37
I have tried all the ssris besides remeron. They ALL make me EXTREMELY TIRED. Do you think remeron will do the same?
Posted by Squiggles on July 31, 2003, at 10:35:09
In reply to Re: REMERON rocks!, posted by matthhhh on July 31, 2003, at 10:29:14
I'm just a layman, so it would be
wise to look at Dr. Ivan Goldberg's site -
he is very good. I would take a guess though,
that Remeron is good for you, depending
on your type of depression, if you have
anxiety and insomnia, and this drug like
many, is very dose-dependent and has
some paradoxical aspects to the dose (i.e.
the higher the dose the less you sleep).It is not an SSRI - it is a NSAD - i think.
Squiggles
Posted by john Henry on July 31, 2003, at 11:26:55
In reply to Re: REMERON rocks! » matthhhh, posted by Squiggles on July 31, 2003, at 10:35:09
I have heard remeron classified as a NaSSAs for norepinephrine and serotonin specific(not reuptake inhibitor like SSRI'S) anti depressant.but it easier to classify it as a serotonin(5-ht2a and 5ht2c) and norepinephrine(a-2)receptor antagonists
Basically it is a blocker at receptor sites.When you block certain serotonin receptors you get certain effects.Here is what happens when you block these sites:
Histamine-1 receptor:Sedation
5ht2a:anti-depressant effect,increased rem sleep and an anti-anxiety effect
Alpha-2 NE receptor:anti-depressant effect,arousal and increased libido
Alpha-1 NE receptor:hypotension,sedation
5ht2c:anti anxiety effect,increased appetite
5ht3c:anti-nauseant effect
Remeron binds to histamine 1st,that is why there is so much sedation at lower doses.Its weird because the higher the dose the more it binds to Alpha-2 NE which is resposible for arousal and libido.Hence the arousal cancels the sedation at higher doses.It binds to 5ht2c which is why you tend to see weight gain.I take Remeron and it is the best sleep I ever get.It has a long half life so for me groginess is a problem.I only use it at 15 mgs.I don't think Remeron is good for dysthmic depressives as the tiredness can lead to irritability and agitation.In theory Remeron + an SSRI or WELLBUTRIN is a power combo,hitting RECEPTORS everywhere.Personally I love Remeron And the first few doses feel like you are going under general anesthesia,but its very pleasant.You will either love it or hate it.
I'm just a layman, so it would be
> wise to look at Dr. Ivan Goldberg's site -
> he is very good. I would take a guess though,
> that Remeron is good for you, depending
> on your type of depression, if you have
> anxiety and insomnia, and this drug like
> many, is very dose-dependent and has
> some paradoxical aspects to the dose (i.e.
> the higher the dose the less you sleep).
>
> It is not an SSRI - it is a NSAD - i think.
>
> Squiggles
>
Posted by Squiggles on July 31, 2003, at 11:33:34
In reply to Re: REMERON rocks! » Squiggles, posted by john Henry on July 31, 2003, at 11:26:55
Gosh john,
You took the words right out of my mouth (lol);
thanks for the elaboration.
Squiggles
Posted by john Henry on July 31, 2003, at 12:07:20
In reply to Re: REMERON rocks! » john Henry, posted by Squiggles on July 31, 2003, at 11:33:34
No problem Squiggly:) I could go on and on about Remeron.Although,in my opinion it's might not be the best AD out there ,it's effects are mild and nice.For me no side effects and the best dreams I've ever had!!!! When you combine remeron which has mild blockade effects with Effexor or an SSRI just hitting the 5ht and NE for Effexor,you have a nice combo.If combined with Wellbutrin you have the dopamine/ne reuptake with Remeron working the Serotonin,nice mixture.And I'm sure Wellbutrin might help the morning groginess.I've never experimented with higher doses but I imagine you could negate all the bad sides from other drugs.It gives you an antinauseant effect,increases your appetite,fights insomnia,at high doses its suppossed to combat sexual dysfunction by libido increase and I wonder since its most potent site it binds to(histamine blockage) you could get rid of allergies or even help with allergic reactions.So as you say.....Remeron Rocks!!!!
Take care
> Gosh john,
>
> You took the words right out of my mouth (lol);
>
> thanks for the elaboration.
>
> Squiggles
Posted by cubbybear on July 31, 2003, at 21:39:30
In reply to REMERON rocks!, posted by Squiggles on July 31, 2003, at 8:51:37
Hello Squiggles,
I know this post has nothing to do with Remeron, but I tried posting for you a few weeks ago, hoping you were still around, but got no reply. Now I know you're still alive and kicking.I recall a post from you from last year saying that it took you about 1-1/2 years to get off a mere 1 mg. of Klonopin. I'm presently tapering off K at the rate of .125mg/day every 10 days and I've gone down from a high of 4 mg in the beginning to 1.75 now. Am doing fairly well with the taper so far but have discovered that I'm super-sensitive to reductions--that's why I'm going so slowly. (I've experienced some anxiety after two previous reductions.)
I'm curious to know about your experience with that last 1 mg. How did you finally manage it? Did you have a pre-set schedule, or were you just shaving off crumbs toward the end? Any info on getting off the last 1.5 mg would be much appreciated.
Posted by Squiggles on July 31, 2003, at 21:50:08
In reply to Re: Can we talk about Klonopin? » Squiggles, posted by cubbybear on July 31, 2003, at 21:39:30
Hi cubbybear,
I did not succeed in getting off Rivotril.
During the last chunks, things got harder
and harder (though the rate was ever so
slow) - hyperthermia, blood pressure swings,
psychological disturbances, severe anxiety,
insomnia, diarrhea, electric sensations in
the head, gastro problems, and other stuff
i cannot recall.During the last phase of 0.125 mg Klonopin
(Rivotril), things got worse and worse.
Whether the lithium had gone up, or the
hottest summer dehydrated me with the diarrhea,
or whether it was just withdrawal itself,
i had a very disturbing head damage incident -
an aneurysm, or a stroke, or a seizure - not
sure which - maybe even neuroleptic syndrome.I was very sick for a month and under my
husband's advice i reinstated the whole dose.
This stopped the freaking out stage near
the end, where i was very anxious and
losing it. However, the sudden "fire in the
head with an axe like hit in the back"
may have been independent - don't know if
the reinstating helped that but i did recover
in about 30 days. It was the worse headache
i had in my entire life - daily.So, if the end stage of withdrawal is
the problem i would recommend a m-u-c-h
slower taper at that stage. But as i said
it could have been the heat or lithium going
toxic due to diarrhea caused by withdrawal.Isn't medicine fun;
Good luck and remember i was taking K for
about 16 yrs. which makes a difference.Squiggles
Posted by cubbybear on August 1, 2003, at 4:42:01
In reply to Re: Can we talk about Klonopin? » Squiggles » cubbybear, posted by Squiggles on July 31, 2003, at 21:50:08
Dear Squiqqles,
Thanks much for your reply. That was quite a story, unlike anything I expected. I was wondering why you take lithium? Do you suspect that perhaps it made the Klonopin/Rivotril reduction that much more difficult?
Posted by Squiggles on August 1, 2003, at 8:32:05
In reply to Re: Can we talk about Klonopin? » Squiggles, posted by cubbybear on August 1, 2003, at 4:42:01
I take lithium because it was prescribed
about 23 years ago for the diagnosis of
bipolar. I suspect that a 600 rather than
900mg dose may have spared me the thyroid
problems, and Synthroid supplementation,
but i am no doctor.As for its effect with the Klonopin, lithium may
have risen in the absence of the sedative
effect on the brain -- this is all fanciful
speculation. Your psychopharmacologist
may know for sure :-)Squiggles
Posted by Squiggles on August 1, 2003, at 9:13:53
In reply to Re: Can we talk about Klonopin? » Squiggles » cubbybear, posted by Squiggles on August 1, 2003, at 8:32:05
Sorry,
i meant "in the absence of the sedative
effect of Klonopin" the lithium may have
gone up. However, if you read anecdotal
stuff on benzo.org, Klonopin is notoriously
difficult to get off from - I think Rand
had said that it has an extra ring in
its molecular structure or something like
that. I don't know why Klonopin is different
from others but i think it is and unfortunately,
Dr. Ashton did not do Klonopin studies
in her clinic.Squiggles
Posted by Bob on August 1, 2003, at 16:47:07
In reply to REMERON rocks!, posted by Squiggles on July 31, 2003, at 8:51:37
Well, I don't know if I cold agree that it's the best AD out there. The weight gain is significant and inescapable for most who take it. The sedation can be overwhelming at low doses, with anger and aggressiveness at higher doses. Also, I'm not sure how effective it is at fighting rumination and obsessive thinking, which many have as a concomitant problem with their depression.
Posted by Squiggles on August 1, 2003, at 17:12:53
In reply to Re: REMERON rocks!, posted by Bob on August 1, 2003, at 16:47:07
Chacun a son gout Dr. Bob,
as they say in the psychiatric
biz. :-)Squiggles
Posted by Bob on August 1, 2003, at 22:55:20
In reply to Re: REMERON rocks! » Bob, posted by Squiggles on August 1, 2003, at 17:12:53
> Chacun a son gout Dr. Bob,
> as they say in the psychiatric
> biz. :-)
>
> SquigglesHuh? Do you think I'm Dr. Bob? What does "Chacun a son gout" mean?
Bob
Posted by linkadge on August 2, 2003, at 4:10:13
In reply to Re: REMERON rocks! » Squiggles, posted by Bob on August 1, 2003, at 22:55:20
I've heard that Remeron increases 5ht neurotransmission but how is this possible if it has no reputake capabilities. I understand it blocks some serotonin receptors but how does this lead to increase 5ht neurotransmission.
Linkadge
Posted by cubbybear on August 2, 2003, at 6:27:52
In reply to Re: Can we talk about Klonopin? correction » Squiggles, posted by Squiggles on August 1, 2003, at 9:13:53
Squiggles,
Thanks for all your help regarding this medication. Well. . .all I can do is hope that my tapering will be something I can tolerate to the finish line.
cubbybear
Posted by Squiggles on August 2, 2003, at 6:31:16
In reply to Re: REMERON rocks! » Squiggles, posted by Bob on August 1, 2003, at 22:55:20
Yes, i thought you were Dr. Bob.
It means "to each according to his taste";
Squiggles
Posted by Squiggles on August 2, 2003, at 6:45:27
In reply to Re: Can we talk about Klonopin? correction » Squiggles, posted by cubbybear on August 2, 2003, at 6:27:52
Good luck cubbybear,
I didn't mean to scare you. If you have
not been taking it as long, and you take
a very slow taper, it is unlikely you will
get those w/d symptoms. If you are under
the care of a dr., perhaps he or she can
help you with the aid of another benzo
to withdraw.If you like, send me a copy of your progress
as you get there. I would be happy to
see how you are doing. Again, i think
i am the exception for *such* a bad withdrawal.Squiggles
Posted by rod on August 2, 2003, at 6:47:57
In reply to How does Rem increase 5HT, posted by linkadge on August 2, 2003, at 4:10:13
> I've heard that Remeron increases 5ht neurotransmission but how is this possible if it has no reputake capabilities. I understand it blocks some serotonin receptors but how does this lead to increase 5ht neurotransmission.
>
>
> LinkadgeHi linkadge,
I once looked it up myself, so here it comes:
Remeron blocks alpha2-Autoreceptors and alpha2-heteroreceptors. alpha2-autoreceptors are the usual norepinephrine autoreceptors. The are negativley coupled to the release of norepinephrine. I guess you know how this works. But Remeron , unlike Mianserin, has an equal affinity towards alpha2-heteroreceptors. alpha2-heteroreceptors are Autoreceptors, located at serotonergic neurons, which inhibit upon activation (like all autoreceptors) the release of serotonin. but alpha2-heteroreceptors do not get activated by serotonin but norepinephrine (hetero = different, other). It seems like norepinephrine is also controlling the serotonergic system. (I guess also vice versa) fascinating, isnt it? But the effect of this blockade is increased serotonergic neurotransmission. Like Lithium, but this one targets serotonergic autoreceptors, which are activated by serotonin...
There is a nice picture on the web, but it comes from switzerland, so it is in german. But the used terms in this graphic are very similar to the english ones.
http://www.kssg.ch/fachbereiche/klinikeninstitute/psychosomatik/img/remeron9.jpgRoland
Posted by cubbybear on August 2, 2003, at 7:49:44
In reply to Re: Can we talk about Klonopin? correction » Squiggles » cubbybear, posted by Squiggles on August 2, 2003, at 6:45:27
> Good luck cubbybear,
>
> I didn't mean to scare you. If you have
> not been taking it as long, and you take
> a very slow taper, it is unlikely you will
> get those w/d symptoms. If you are under
> the care of a dr., perhaps he or she can
> help you with the aid of another benzo
> to withdraw.
>
> If you like, send me a copy of your progress
> as you get there. I would be happy to
> see how you are doing. Again, i think
> i am the exception for *such* a bad withdrawal.
>
> SquigglesThanks so much for your caring. We haven't communicated in the past, so I'll give you the scoop on the Klonopin for me. I presently live in Thailand (and plan to return to L.A. by early next year. Klonopin is called Rivotril here.) I was put on 4 mg/day for my insomnia exactly one year ago (when I was severely depressed). Initially, I was tapering at the rate of .25 mg every 7 days but ran into a rotten kind of anxiety withdrawal when I got to 2.50 mg. I had to quit on this idiot doctor,who was hell bent on rushing me along, and he refused to write a script to let me backpedal or even stay at that dosage. My present pdoc is just the opposite of a benzophobe: he's a real cold fish who seems like a big nothing and he sees nothing wrong with a person who's prone to anxiety to stay on Klonopin indefinitely. I personally want to quit it so I can rely entirely on the anxiolytic qualities of my anti-depressant, Parnate and to be free of having to make the Klonopin purchases and spend money for the doctor visits.
I got a bit off on a digression here--but the thing is, that when I encountered the withdrawal anxiety, I decided to cut the tapering to .125 mg every 7 days. I'm now planning on going to 1.625 mg tonight and spacing my decreases to every 10 days. You can see how slow a taper this is, but I seem to be quite sensitive. Apparently this drug really got a hold on me and so I want to go at a snail's pace to avoid withdrawal anxiety or other problems as much as possible. Now you know the story. Thanks again, Squiggles.
Posted by Squiggles on August 2, 2003, at 10:47:38
In reply to Re: Can we talk about Klonopin? » Squiggles, posted by cubbybear on August 2, 2003, at 7:49:44
You may have to resign yourself to the
possibility that you cannot get off
Klonopin (we call it Rivotril in Canada too)
if you are having an impossible time getting
off.If that happens, and some doctors may actually
be cautious about that -- there is one good
thing about Klonopin that you do not find
in other benzos: you do not have to increase
the dose often to prevent tolerance.In the 16 yrs or so i have been taking it
i think my dose has risen 3x - from 0.50
to 1.50 - which is what i am taking now.So, your options are not so bad.
Take care
Squiggles
Posted by cubbybear on August 4, 2003, at 1:01:56
In reply to Re: Can we talk about Klonopin? » Squiggles » cubbybear, posted by Squiggles on August 2, 2003, at 10:47:38
> You may have to resign yourself to the
> possibility that you cannot get off
> Klonopin (we call it Rivotril in Canada too)
> if you are having an impossible time getting
> off.
>
> No, so far I'm not having an impossible time tapering. But please don't tell me things like this.
This is the end of the thread.
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