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Author Topic: Considering a Taper off of Remeron because of Weight Gain  (Read 509 times)

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Offline Andrew90

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Considering a Taper off of Remeron because of Weight Gain
« on: January 01, 2014, 04:35:49 PM »
Happy new year all,

So to help treat my anxiety, I am currently on the regimen of 45 mg Remeron, 3 mg Guanfacine, and 1 mg Klonopin daily. I have been on Remeron since early September, Klonopin since early October, and Guanfacine since mid-October. I have noticed that over the past month or so, I have been putting on some extra weight, to the extent that I have a 'belly' now. Historically I have always been very thin, and it has only been until recent that I've added a few pounds. I am 23, am 5"11' and weigh 164 lbs, which does fall under the normal BMI category, but nevertheless I feel that I will continue to tack on pounds unless I make a change. My eating habits have changed little, as have my exercise habits, so I believe that the mirtazapine may be the culprit in slowing my metabolism. I have read many anecdotal stories of people who took mirtazapine and no other medications, and gained weight despite not changing their eating or exercise habits. Additionally I am aware that weight gain is one of the most reported side effects of Remeron. Although I am not 100 % sure that the Remeron is to blame, I am willing to take the chance to step down on dosage to see if I can lose my 'belly'. I am visiting my pdoc early next week and will discuss this with him, and am thinking of stepping down from 45 mg to 30 mg, holding there for two weeks, and then stepping down to 15 mg. At 15 mg it acts more as an anti-histamine, so I will see if I have any progress with losing weight at a lower dose.

I would like to emphasize that I am very health conscious and am somewhat of a hypochondriac, so for me it is important from a psychological perspective (and in the interests of my health) to keep a healthy BMI and not gain added weight.

I am interested as to the thoughts from the community about my plan to taper off of Remeron in my interests to lose some weight. I will gauge how I feel upon tapering off of it, as I really can't tell how well it has been helping my anxiety at this point. I think the Klonopin is much more helpful in preventing panic attacks and keeping me more leveled. If I do have increased anxiety after going off of the Remeron, I may consider another medication to take its place. But, I would prefer less medications if possible.

Any input on this from you guys would be very much welcomed.

Thanks!
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Offline Abraham2007

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Re: Considering a Taper off of Remeron because of Weight Gain
« Reply #1 on: January 01, 2014, 06:09:28 PM »

Getting of Mirtazapine (Remeron) should be a good option for you, considering it is well known to cause weight gain, and since weight gain is a concern for you (believe it or not, for some people, it isn't) then there's no point in getting fat just to manage your anxiety.  Likewise a few current AZ posters can testify how unexpectantly this med can just "poop out" on you.   However the medication does alleviate anxiety, so if you aren't really experiencing panic attacks at the moment, you really should be giving more credit to Remeron than you think.   You probably will experience increased anxiety once you get off it, unless you get on a different anti anxiety medication to manage your anxiety disorder.   You could decide to take another med later, after getting off Remeron, but considering your panic attack history, you're really playing russian roulette to not have a medication to ground you.

Klonopin is a good med to alleviate anxiety, particularly GABBA levels, in order for you to calm down.   If your psychiatrist is willing to write you a never ending prescription of Klonopin, you may have that med to manage your anxiety.  Do note the withdraw levels off a benzodiazepine are not very pleasant, so you should expect to be on a benzodiazepine for a long time.

However, I remember reading your previous posts about issues with ADHD, so there are issues beyond your brain's lack of glucocorticoid receptors, which could be supplied by a benzodiazepine like Klonopin (Clonazepam).  Also if you're taking Guanfacine, you're taking a blood pressure medication to work as a psychiatric medication.  I guess if it works for now, you can choose to stay on it, however I don't think you'll get optimum results with just Guanfacine and Klonopin.

If you have an anxiety disorder, and you've experienced panic attacks from hell (and I have too), then you want to be on the best medication type, so you don't experience them again.  I think your best is to get on a antidepressant, or a SSRI.  These medications are the best treatments for chronic anxiety disorders.  In addition, antidepressants affect the two hippocampi, which are important for learning, as well as repair damage around your prefrontal cortex.  The reason why this is important for you is that an antidepressant, at the correct dosage, could do a better job in managing the problems with focus and your ability to remember learning material, that you maybe having in school.  Klonopin and Guanfacine will not assist in this.

If you're resistant to SSRIs because of their sexual side effects, raise those concerns with your psychiatrist, and the two of you can work around this obstacle.  Ian can also direct you to a post he created on Anxiety Zone about working around sexual dysfunction with antidepressants.  Also you may want to google herbs that affect the libido, which some antidepressant users claim to have upped their sexual drive.  If you want to pursue them, you can ask your psychiatrist about his recommendations.



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Offline insights

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Re: Considering a Taper off of Remeron because of Weight Gain
« Reply #2 on: January 01, 2014, 07:06:58 PM »
and am thinking of stepping down from 45 mg to 30 mg, holding there for two weeks, and then stepping down to 15 mg. At 15 mg it acts more as an anti-histamine, so I will see if I have any progress with losing weight at a lower dose.

The problem is that 15mg/day will be an ineffective dose so, IMHO, there is no point in taking it.

Quote
I think the Klonopin is much more helpful in preventing panic attacks and keeping me more leveled.

While Klonopin is usually a very effective anti anxiety med, IMHO, it should not be your primary med because of the uncertainty of getting prescriptions. You doctor may be happy to prescribe it today, but be less willing in the future. He could also fall under the proverbial bus tomorrow and be replaced by a benzophob.

If you prefer not to take medication then the cognitive and/or behavioural and/or mindfulness therapies can be as effective as antidepressants.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline Andrew90

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Re: Considering a Taper off of Remeron because of Weight Gain
« Reply #3 on: January 01, 2014, 09:00:25 PM »
I agree with you that 15 mg is probably a futile dosage, so if I'm going to step down on the Remeron, I should drop it to 30 mg, see how I feel, and if I'm not overly anxious, then I will continue to taper off of it until I'm off the medication.

With regards to the antidepressants, I have gone on the SSRI merry-go-round and have tried such ones like Zoloft, Prozac, and Celexa. I didn't like those because they made me very lethargic and tired, plus they gave me sexual dysfunction. Additionally I have taken Effexor and Wellbutrin, both of which were effective as antidepressants, but I feel that Wellbutrin would probably be one of the worst AD's for anxiety, and Effexor also gave me sexual dysfunction. Effexor was far and away the most effective AD I had tried, both in terms of depression and anxiety, but it gave me brain-zaps and like I said, sexual dysfunction.

I am aware of a newer AD by the name of Viibryd, which supposedly is designed not to induce sexual dysfunction. Does anyone know how Viibryd fares for people with anxiety, and not just depression? Like Remeron, it is approved for the treatment of Major Depressive Disorder, but I don't see any indications for generalized anxiety disorder or panic disorder.

I will have a full discussion with my pdoc about options regarding a replacement of the Remeron, but in the interim any advice you guys have is most certainly appreciated.
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Offline Andrew90

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Re: Considering a Taper off of Remeron because of Weight Gain
« Reply #4 on: January 01, 2014, 09:07:27 PM »
I'd like to add that I think it's a shame that Lyrica isn't approved for GAD in the United States like it is in Europe, as that would very possibly be a great replacement for the Remeron. Additionally, from what I've read, Lyrica is probably a helpful "cushion" for when it comes time to wean off of a benzo.

Lyrica is unfortunately too expensive, but its closest and more affordable relative gabapentin seems to give people mixed results in terms of treating anxiety. It's another idea, but my pdoc probably won't vouch for that as a first-line treatment for anxiety, because it isn't.
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Offline insights

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Re: Considering a Taper off of Remeron because of Weight Gain
« Reply #5 on: January 01, 2014, 10:31:43 PM »
I am aware of a newer AD by the name of Viibryd, which supposedly is designed not to induce sexual dysfunction.

Viibryd is merely a SSRI combined with a Buspar like chemical in the one tablet. You can achieve the same result by taking any SSRI with Buspar. This would have the advantage of not being locked into a fixed ratio so you could fine tune the Buspar dose for optimum results.

Quote
I'd like to add that I think it's a shame that Lyrica isn't approved for GAD in the United States like it is in Europe, as that would very possibly be a great replacement for the Remeron.

...Lyrica is unfortunately too expensive, but its closest and more affordable relative gabapentin seems to give people mixed results in terms of treating anxiety. It's another idea, but my pdoc probably won't vouch for that as a first-line treatment for anxiety, because it isn't.

Lyrica (pregabalin) is unlikely to be any more effective than gabapentin. It works well for a few, but not for most. IME, most of the non benzodiazepine seizure meds are of limited effectiveness. They are very much fifth or sixth order anti anxiety meds. The ones you reach for when everything else has failed.

Trazodone would be a much better bet than either pregabalin or gabapentin. Your main problem is likely to be getting past the sedation. This is more severe at the lower doses and drops off at the therapeutic range - 225mg plus, especially with the slow-release formulation. If sedation hasn't been a significant concern with Remeron then it may not be with trazodone either.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline dh1972

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Re: Considering a Taper off of Remeron because of Weight Gain
« Reply #6 on: January 02, 2014, 02:40:26 PM »
Insights,

Would 15 mg of Mirtazapine offer any anti-anxiety benefit for someone with moderate general anxiety?  Also, would it still stimulate carb appetite?
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Offline insights

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Re: Considering a Taper off of Remeron because of Weight Gain
« Reply #7 on: January 02, 2014, 04:23:23 PM »
Would 15 mg of Mirtazapine offer any anti-anxiety benefit for someone with moderate general anxiety? 

Probably not enough to make it worthwhile taking.

Quote
Also, would it still stimulate carb appetite?

It may do. Of course exercise would help, both in keeping the weight down and for reducing anxiety too.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline dh1972

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Re: Considering a Taper off of Remeron because of Weight Gain
« Reply #8 on: January 02, 2014, 04:57:08 PM »
Could Buspar combined with 15 mg of Mirtaz help the anti-anxiety?
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Offline insights

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Re: Considering a Taper off of Remeron because of Weight Gain
« Reply #9 on: January 02, 2014, 06:19:39 PM »
Could Buspar combined with 15 mg of Mirtaz help the anti-anxiety?

It may do, but perhaps only marginally.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline Andrew90

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Re: Considering a Taper off of Remeron because of Weight Gain
« Reply #10 on: January 02, 2014, 06:28:11 PM »
I've been giving this a lot of thought, but perhaps I should try to stay with the mirtazapine but at a lower dose, even if the anti-anxiety effect weakens. Realistically, I won't know how I'll respond to a lower dose until I try it out for a few weeks. I want to strike a balance between mitigating the weight gain and my anxiety, so maybe trying 30 mg for a time might be worth it instead of just attempting to get off this med asap. Switching to a different med is kind of a long process that can cause more instability for a time, and I definitely do not want to pile on more anxiety. Some of that may be inescapable with lowering the dosage, but I may still fare fine. If I can lose a few pounds at 30 mg or 15 mg, then I'll happily stay on this drug.

Would the weight gain properties of this drug be lesser at a lower dosage?
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Offline Andrew90

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Re: Considering a Taper off of Remeron because of Weight Gain
« Reply #11 on: January 02, 2014, 06:41:41 PM »
Insights,

I have read that with Trazodone there is a potential for cardiac arrythymias, which is something that really turns me off about that drug. I know it's probably rare, but I have some degree of cardiophobia and get occasional PVC's when my anxiety ramps up, so I don't think this medication would be helpful for my anxiety. My main purpose is to treat anxiety, not depression, so I don't think I'd give this drug a try. I'd rather try Viibryd over trazodone.

I will of course speak about all this with my pdoc, and will update you guys when I've had my appointment early next week.
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Offline insights

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Re: Considering a Taper off of Remeron because of Weight Gain
« Reply #12 on: January 02, 2014, 07:48:13 PM »
I'd rather try Viibryd over trazodone

You'd be better off going with a SSRI plus Buspar because this is essentially what Viibryd is, a SSRI combined with a Buspar like compound. Taking two drugs allows you to fine tune each, instead of having a fixed ratio.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline dh1972

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Re: Considering a Taper off of Remeron because of Weight Gain
« Reply #13 on: January 03, 2014, 12:17:38 PM »
Insights,

I have read that with Trazodone there is a potential for cardiac arrythymias, which is something that really turns me off about that drug. I know it's probably rare, but I have some degree of cardiophobia and get occasional PVC's when my anxiety ramps up, so I don't think this medication would be helpful for my anxiety. My main purpose is to treat anxiety, not depression, so I don't think I'd give this drug a try. I'd rather try Viibryd over trazodone.

I will of course speak about all this with my pdoc, and will update you guys when I've had my appointment early next week.

I find Trazodone works well for sleep as I've had my share of insomnia issues the last 6 months, but it does make my anxiety worse every time I go on it even at 25mg-75mg.  I am not sure why.  My general Dr. and sleep Dr. said they never saw that in their patients before.  However, I am very sensitive to any medication perhaps because I have used very little until this past year when I started developing anxiety and sleep issues.   (I even got C-diff once while taking Zithromax for a sinus infection - an antibiotic I had used a number of times previously with zero issue - go figure).
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Offline dh1972

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Re: Considering a Taper off of Remeron because of Weight Gain
« Reply #14 on: January 03, 2014, 12:18:37 PM »
Could Buspar combined with 15 mg of Mirtaz help the anti-anxiety?

It may do, but perhaps only marginally.

Ian

Is it at least safe to use together?

I ask because I resumed Buspar about 4 days ago and feel like it is having a subtle effect on helping my anxiety.
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