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Author Topic: I want to go off of 15mg of Remeron. Need Suggestions.  (Read 282 times)

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Offline CDG

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I want to go off of 15mg of Remeron. Need Suggestions.
« on: January 17, 2014, 01:19:02 AM »
How hard is it to come off that dose?  I have been taking 15 mg remeron for about 9 months.  I take it with 600 mg of trileptal and 1mg prazosin at bedtime.  I also take 1mg of Ativan twice a day.. Morning and late afternoon.  My pdoc says to go off of it as I am feeling way to drowsy in the mornings.  I am also gaining weight and the morning hunger almost makes me sick in the last hour or so of sleep.  She feels there is not enough in my system for a therapeutic effect or to have a withdrawl.  It's not doing anything but making me sleepy.  She says to go down to 7.5 for a week then go off them.  I also am gonna gradually go up to 1200 on trileptal.

With that said..  Does that titration schedule make sense?  Will I have withdrawals at that 15mg dose?  Is it possible or even likely that the other drugs will mask or cancel them out?  Has anyone had experience doing this? Will the increase in metabolism effect the other drugs.. Like the Ativan? 

I have read a lot of bad things about getting off of this.  Most of those were about people getting off of much higher doses.  Like 30-135 mg.   those titration schedules are way longer and more complicated than she suggested.

Thank you for any help here..
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Re: I want to go off of 15mg of Remeron. Need Suggestions.
« Reply #1 on: January 17, 2014, 02:06:12 AM »
I have been taking 15 mg remeron for about 9 months.  I take it with 600 mg of trileptal and 1mg prazosin at bedtime.  I also take 1mg of Ativan twice a day.

You are taking three of these, Remeron, Trileptal and prazosin at below their typical therapeutic doses, and the latter two should be taken several times a day because of their short half-lives. I suspect the only drug having a worthwhile effect is the Ativan.

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I am also gaining weight and the morning hunger almost makes me sick in the last hour or so of sleep.

Remeron is notorious for producing carbohydrate cravings, however, Trileptal may also be contributing as it upsets the body's salt balance which can lead people to crave salty foods such as potato chips, etc. It also increases the amount of water retained in the body which probably accounts for some of your weight increase.

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She feels there is not enough in my system for a therapeutic effect or to have a withdrawl. It's not doing anything but making me sleepy.  She says to go down to 7.5 for a week then go off them.

I wouldn't expect much of a reaction. The dose probably hasn't been high enough to initiate the typical brain changes seen at therapeutic doses.

But be aware that psychology is as least as big a factor in withdrawal as chemistry. Expect to suffer and your mind may oblige. 

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I also am gonna gradually go up to 1200 on trileptal

IMHO you'd get better results from an antidepressant at therapeutic doses.

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 CDG

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Re: I want to go off of 15mg of Remeron. Need Suggestions.
« Reply #2 on: January 17, 2014, 08:54:01 PM »
I can't take anti-depressants.  I have a horrible reaction.  Not tolerant.  I had to go to a crisis stabilization unit.  That is why I take trileptal.  Plus I have severe head tension.  It suppose to help with pain and anxiety.
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Re: I want to go off of 15mg of Remeron. Need Suggestions.
« Reply #3 on: January 17, 2014, 11:09:48 PM »
I can't take anti-depressants.  I have a horrible reaction.  Not tolerant.  I had to go to a crisis stabilization unit.  That is why I take trileptal.

Remeron is an antidepressant so you're able to tolerate at least one. What med were you taking when you had the reaction? An SSRI?

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.

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Re: I want to go off of 15mg of Remeron. Need Suggestions.
« Reply #4 on: January 20, 2014, 10:56:35 PM »
Yes Ian.  An ssri's.  Zoloft the 1st time.  Pristiq the second and final time.  It caused my anxiety to go through the roof.  Uncontrollable.  Thoughts on better alternatives to an ssri's?
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Re: I want to go off of 15mg of Remeron. Need Suggestions.
« Reply #5 on: January 21, 2014, 02:03:14 AM »
Yes Ian.  An ssri's.  Zoloft the 1st time.  Pristiq the second and final time.  It caused my anxiety to go through the roof.  Uncontrollable.  Thoughts on better alternatives to an ssri's?

One of the tricyclic antidepressants (TCAs) with strong norepinephrine, aka noradrenaline, reuptake activity such as imipramine (Tofranil), desipramine (Norpramin) and amitriptyline (Elavil). They have a similar mode of action as Remeron, but have a higher dose range and are much, much less likely to stop working.

Start on a low dose, many TCAs come in 10mg starter tablets which is a tiny amount compared to the typical 75mg minimum therapeutic dose. Increase by no more than 10-25mg every 7-10 days until you get to the target dose. Done this way you should experience little if any startup anxiety. The drawback is that the TCAs have more ongoing side-effects, mostly dry mouth and constipation, but these can be managed and tend to lessen over time.

Given you could apparently tolerate Remeron's sedation, trazodone (Desyrel) is another possibility. It works in much the same way as the TCAs, but has fewer ongoing side-effects (small adjuvant doses are sometimes used to counter both SSRI and TCA side-effects). Its main drawback is that it is at least as sedating as Remeron though this diminishes at the higher antidepressant doses, especially if you take a slow-release formulation. Another potential drawback is that, unlike most other antidepressants, it enhances the libido. Also be aware that it only becomes an antidepressant at doses above 150-225mg/day. Below that it is only a powerful antihistamine, as are most TCAs and some SSRIs. It is the effect on histamine receptors which produces the sedation.

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.

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Re: I want to go off of 15mg of Remeron. Need Suggestions.
« Reply #6 on: January 22, 2014, 12:30:20 AM »
Thanks Ian.  Your a great help.  Will the tricilic anti-d's help with PTSD symptoms.  Will they make me gain weight like Remeron.  It's the main reason I am getting off of it.
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Re: I want to go off of 15mg of Remeron. Need Suggestions.
« Reply #7 on: January 22, 2014, 12:55:33 AM »
Thanks Ian.  Your a great help.  Will the tricilic anti-d's help with PTSD symptoms.

Sure. They can do everything an SSRI can, sometimes better. 

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Will they make me gain weight like Remeron.  It's the main reason I am getting off of it.

They may do, most antidepressants can, however, Remeron is in a league of its own when it comes to carb cravings and weight gain. People will literally eat sugar straight from the bag while they're on it.

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.

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Re: I want to go off of 15mg of Remeron. Need Suggestions.
« Reply #8 on: January 22, 2014, 11:17:26 PM »
Which one is the best for not gaining weight.  Like not slowing your metabolism.  That seems to be the problem. 
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Re: I want to go off of 15mg of Remeron. Need Suggestions.
« Reply #9 on: January 23, 2014, 12:04:58 AM »
Which one is the best for not gaining weight. 

The tricyclics most likely to trigger weight gain are amitriptyline, doxepin and imipramine. However, compared to the Remeron plus Trileptal combination you've been on they would almost be weight loss pills. Trazodone is generally neutral.

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Like not slowing your metabolism.

There is little evidence that antidepressants cause weight gain by slowing metabolism, and quite a bit showing people eat more when taking them, especially the wrong foods.

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.

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