# SSRI/SNRI + mirtazapine (Remeron) combination -- too optimistic? Experiences please.



## euphoria (Jan 21, 2009)

I'm looking for any experiences on using mirtazapine combinations, such as the famed 'Rocket Fuel'. Research suggests such combos are highly effective for patients like myself (resistant depression & other disorders), but actual experience reports are scarce on the internet and it's hard to know exactly what it feels like to be on this, and what areas it can help. I am trying this in a few weeks if mirtazapine still doesn't help enough.

Personal history and notes on self in small text, skip past if you don't care:

I believe I've had some form of mental peculiarity since birth, which started out as heavy introversion, lack of social drive, no assertiveness and a general inability to 'thrive' and engage with / enjoy life as much as others. To this day I feel I lack some crucial 'spark' that drove everyone else forward, and with the increased social pressures of my teenage years came social anxiety, anhedonia, depression, and a lot more. Before those 'pressures' I was somewhat different, but still capable of happiness if I followed a certain lifestyle. I think that door is now closed and only a combination of meds, therapy and a lot of time will begin to re-open it.

I don't have a low self-esteem; my failure at life I put down to some sort of brain abnormality that could be genetic. I don't blame my upbringing -- my folks are the nicest and most competent parents in the world. I'm not unintelligent, physically ugly or fat, or at any other obvious observable disadvantage. You could say it's just my personality, but when my personality means I am doomed to be unhappy with just about any form of human contact, it's not one I intend to keep (at least the bad parts anyway). Maybe I can become a recluse when I'm older, but for now human contact is a necessity.

When your brain is naturally configured to derive such a minimal amount of enjoyment from any normal activity of life, drugs can be both a miracle and a one-way ticket to dependency. I found that the more selective a drug is to dopamine, the more effective it is for just about every problem I have. When I've taken pure dopamine-acting drugs I experienced everything "click into place" and I was 'normalised', with motivation, interest, enjoyment, concentration, sociability and everything else finally making sense. I was finally able to tolerate life, not because of some high, but because everyone needs a certain amount of these chemical effects to keep the brain ticking over. What might get user A high may just get user B normal, and there are big differences between recreational and therapeutic use of dopaminergics, not the least of which being dose. Unfortunately the means with which to target dopamine are currently limited and burdened with side-effects like anxiety, so I came to the decision that I must first get my anxiety and typical depression under control before directly influencing dopamine (what I feel is very close to the core of my disorder, partly from personality / genes and partly from previous drug use).

Because dopamine itself is so insanely pleasurable, it's hard to separate genuine "hypo-dopaminergic" people from those with unrelated mood disorders, since pumping most people full of dopaminergic drugs would make them more happy and able to tolerate life. It's easy to just write off the whole thing as dangerous territory, which it is if you're not careful.

That brings me to mirtazapine combos. I have tried SSRIs alone before and found they made me happy in some ways but worsened some of my other problems like inability to experience pleasure (anhedonia) and those relating to motivation & concentration. In contrast to dopamine drugs, it didn't feel like an overall "serotonin effect" was really what my brain was craving AKA "the missing jigsaw piece", but it was positive on many levels. I would definitely take the good side of SSRIs if the negatives weren't so pronounced, hence my optimism with mirtazapine augmentation. I am currently on 45mg mirtazapine, which takes the edge off depression/anxiety but also flattens emotions and imagination (in a different way to SSRIs). It's not a bad med for me, but still doesn't control anxiety, anhedonia, depression enough that I'm able to get on with my life. I'm still consistently unhappy, regardless of what I do with myself, and anxiety is still very much a problem.

I think SSRIs alone were never gonna do the trick for me with their anhedonic sides, and whilst mirtazapine seems a better monotherapy for my brain, its benefits remain minor. My pdoc has agreed to add an SSRI if mirt shows no further improvement in a few weeks. Mirt should block the side-effects of SSRIs that previously limited their effectiveness, and promote a powerful synergy and hopefully relief of most of my symptoms. I don't know how well it will work on motivation/concentration/sociability/anhedonia, but at least it should get me out of this pit of depression and reduce anxiety enough that I can tolerate coffee to boost my brain (e.g. dopamine, noradrenaline, acetylcholine) like the rest of the world, or I suppose more powerful psychostimulants if I eventually discover all that drug abuse has given me real ADD.

So, if any of you have used mirtazapine with other antidepressants, I'm all ears. Specifically I want to know exactly how it made you feel, whether benefits faded over time, whether there were any side-effects, and how it compared to each antidepressant alone. Cheers.


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## db0255 (Jul 20, 2009)

I take Remeron with Prozac now, and used to take Remeron with Strattera and Celexa. 

Remeron works pretty well by itself, but I didn't notice any extra difference with Remeron with an NRI, so IDK what to say.


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## britisharrow (Jun 18, 2009)

I've been on Mirtazapine 45mg for months but will shortly be changing to Mirtazapine + Fluoxetine. I will let you know of any changes.


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## jim_morrison (Aug 17, 2008)

britisharrow said:


> I've been on Mirtazapine 45mg for months but will shortly be changing to Mirtazapine + Fluoxetine. I will let you know of any changes.


Hey britisharrow, I've also been on mirtazapine for a few months now, I'm curious, do you find much of a difference between 45 and 30 mg? From my experince it seems to be that 45 mg = increased efficacy, but at the cost of more side effects, mostly next day somnolence and weight gain, which didnt pass even with 2 months of chronic dosing.


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## nowheretohide (Aug 20, 2009)

I take 120mg Cymbalta and 60mg. Its a great combo. I think the californa rocket fuel is great for treating social anxiety and depression. At the end of june I went to a psychitarist and he put me on 900mg Aurorix and 300mg Lyrica. After six weeks I knew that the meds were not working, I was still very anxious and depressed. I told my unemphatic doctor that the meds were not working and I wanted to try something different. He refused and wanted me to stay on them. I changed doctor after our discussion, which made me realise that my psychatrist was an a******. 
I went to see a new psychatrist six weeks ago. We talked and concluded that my social phobia is probably very deep and treatment resitant. I was desperate at that time, I had done some research and read posts that californa rocket fuel was a very potent combination. I knew that he would never prescibe nardil to me, but california rocket was possible. So I told him that I had tried several SSRIs and effexor at a high dose. I lied I had never tried an SSRI or effexor. But I knew that theye wouldnt be very effective for me becuase of my high degree of social anxiety, which runs in the family. My father has it to. So he prescribed Cymbalta and remeron. The first week I took 60mg Cymbalta and 30mg remeron. After that the dosage was increased to 120mg Cymbalta and 60mg remeron. After two weeks I began to improve. I was happier and less anxiuos. I have been on this combo for moore than six weeks and its great. Iam not anxious anymore when iam out in public or when talking to people. Iam much more optimistic. My anxiety is not completly gone but I have improved wastly. My doctor tells me that as I improve the negative thought patterns that I previously had will be erased and I am going to function more like a normal person. This might take a year or longer.


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## db0255 (Jul 20, 2009)

Being on Prozac and Remeron is like having a jackhammer to my frontal lobe....just a thought.


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## jim_morrison (Aug 17, 2008)

db0255 said:


> Being on Prozac and Remeron is like having a jackhammer to my frontal lobe....just a thought.


lol, Could you go into more detail?


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## db0255 (Jul 20, 2009)

jim_morrison said:


> lol, Could you go into more detail?


Well they both work as 5-HT2C antagonists, and while I think they both do that, Remeron is definitely the more potent. So I have Remeron that is blocking that in the frontal lobe, and Prozac, which for some reason, makes me feel like my frontal lobe is in a vise. It's good in the way that it makes me feel 100% more composed and more myself, but it's not working in the way of making me social, non-depressed.


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## jim_morrison (Aug 17, 2008)

Well I got the all clear from my doc today to try california rocket fuel (adding effexor xr to my current 30 mg remeron) next month, will see how it goes!


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## euphoria (Jan 21, 2009)

I'm starting 50mg sertraline in addition to my 45mg mirtazapine on Monday... probably. I am in serious need of some 5-HT.


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## jim_morrison (Aug 17, 2008)

Sounds cool euphoria, don't I recall you saying that zoloft + mirtazapine once gave you a seizure though??


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## Medline (Sep 23, 2008)

I remember that too, here it is:


euphoria said:


> I'm inclined to believe so, as I took sertraline + mirtazapine and had a seizure.


Could something else at that moment have lowered your seizure threshold (eg. benzo withdrawal)?


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## KurtG85 (Sep 19, 2008)

Mirtazapine worked probably better than any other med I tried at helping my anxiety depression, and generally helping me suddenly 'forget' that I had these issues. However unfortunately it made me so insanely sedated that I wasn't even safe to drive a car. I was on adderall at the same time.


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## euphoria (Jan 21, 2009)

Medline said:


> I remember that too, here it is:
> 
> Could something else at that moment have lowered your seizure threshold (eg. benzo withdrawal)?


Where is that post from?

I don't remember too well, but I believe my seizures were due to excessive magnesium supplementation and mild benzo/pregabalin withdrawal. Those things are not an issue this time, but if I do have a seizure, I am not stopping AD treatment. I will just have to take an anticonvulsant. I am seeing a neurologist about them on Monday.


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## britisharrow (Jun 18, 2009)

jim_morrison said:


> Hey britisharrow, I've also been on mirtazapine for a few months now, I'm curious, do you find much of a difference between 45 and 30 mg? From my experince it seems to be that 45 mg = increased efficacy, but at the cost of more side effects, mostly next day somnolence and weight gain, which didnt pass even with 2 months of chronic dosing.


I didn't notice much difference really between the 30mg and the 45mg but to be honest I don't strictly follow a gradual upping of the dose. I took 30mg for a week and went up to 45mg, much to my doctor's disapproval.

They're bringing me down to 15mg Mirtazapine and 20mg Fluoxetine, but I'll be upping it to 30mg Mirtazapine and 20mg Fluxetine before long. My excuse to the doctor is that I didn't read the instructions properly.

I will of course check on various websites that there ARE people taking those two drugs at THAT level and they ARE still ALIVE. As I do with all medication.

Regarding weight gain and sedation, yes both of them. Almost constant feelings of hunger, I take the Mirtazapine at night or else I'd sleep during the day. They said the higher the dose the less it would sedate me, which may be the case but it still sedates me the same as it did before.


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## Medline (Sep 23, 2008)

euphoria said:


> Where is that post from?


http://www.socialanxietysupport.com...e-affect-the-metabolism-of-mirtazapine-65203/


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## jim_morrison (Aug 17, 2008)

Apparently theres a drug in production called Lu AA24530 which acts as an SNDRI/5HT2C, 5HT2A, 5HT3 and Alpha 2 adrenergic antagonist, it may be the closest single pill equivalent to california rocket fuel.


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## euphoria (Jan 21, 2009)

Hmm.... I don't actually want the 5-HT2A or alpha-2 antagonism mirtazapine gives though. A dual SSRI / 5-HT2C antagonist would be good; I think some are in development.


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## Medline (Sep 23, 2008)

euphoria said:


> Hmm.... I don't actually want the 5-HT2A or alpha-2 antagonism mirtazapine gives though. A dual SSRI / 5-HT2C antagonist would be good; I think some are in development.


Agomelatine is a melatonin agonist, 5-HT2C antagonist and therefor a norepinephrine & dopamine disinhibitor.


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## euphoria (Jan 21, 2009)

Some source online said agomelatine was available in June for us in the UK . After it has a longer safety record I'm gonna ask for a switch. Sertraline + agomelatine sounds good.


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## euphoria (Jan 21, 2009)

Yesterday I started 50mg sertraline in addition to 45mg mirtazapine. Made me feel a bit different, _very_ slight increase in anxiety & negative thinking but not noticeable most of the time. Shouldn't take too long to start working.


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## KurtG85 (Sep 19, 2008)

euphoria said:


> Yesterday I started 50mg sertraline in addition to 45mg mirtazapine. Made me feel a bit different, _very_ slight increase in anxiety & negative thinking but not noticeable most of the time. Shouldn't take too long to start working.


Cool, keep us updated.


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## nowheretohide (Aug 20, 2009)

euphoria said:


> Yesterday I started 50mg sertraline in addition to 45mg mirtazapine. Made me feel a bit different, _very_ slight increase in anxiety & negative thinking but not noticeable most of the time. Shouldn't take too long to start working.


Good luck. You will soon see the benefits of the california rocket fuel. It's very strong and has to be one of the best combos to combat SAD and depression. Last week I had a couple of job interviews, and for the first time in my life I wasnt nervous before or during a job interview. I'm staring to cope with my anxiety much better now, I dont dwell on it as much as I did before which causes my attitude to change.


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## euphoria (Jan 21, 2009)

nowheretohide said:


> Good luck. You will soon see the benefits of the california rocket fuel. It's very strong and has to be one of the best combos to combat SAD and depression. Last week I had a couple of job interviews, and for the first time in my life I wasnt nervous before or during a job interview. I'm staring to cope with my anxiety much better now, I dont dwell on it as much as I did before which causes my attitude to change.


How long did it take to start working? I started sertraline about 3 days ago, but thus far have only noticed a vague feeling of unease and less inclination to bother getting up in the morning. Also there has been some mental difficulty and feeling of disconnection from reality. Definitely not as bad as normal SSRI initiation, but as usual with med trials, doubts are creeping in as to whether this will actually work.


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## jim_morrison (Aug 17, 2008)

euphoria said:


> thus far have only noticed a vague feeling of unease and less inclination to bother getting up in the morning. Also there has been some mental difficulty and feeling of disconnection from reality.


Thats how I feel whenever i take 45 mgs or more of mirtazapine, my advice, reduce the mirtazapine dose to 15 - 30 mg.

Realise that we are dealing with one of the most potent antihistamines on the planet, and whatever mild adrenergic effects it has are unlikely to offset that property.


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## nowheretohide (Aug 20, 2009)

euphoria said:


> How long did it take to start working? I started sertraline about 3 days ago, but thus far have only noticed a vague feeling of unease and less inclination to bother getting up in the morning. Also there has been some mental difficulty and feeling of disconnection from reality. Definitely not as bad as normal SSRI initiation, but as usual with med trials, doubts are creeping in as to whether this will actually work.


Give it some time, hopefully it will work. I increased my doseage to max 120 mg Cymbalta and 60mg remeron after just one week. I only felt sedated and tired the first couple of days I was on this combo. I started to see a real change after two weeks. Now I have been on this combo almost two months. I'm going to start working again on monday, at first anxiuos thought kept creeping back, but I'm able to brush them of much easier then before. The big test is going to be on monday at the work place, but I think I'll do ok, because my attitude has changed. I dont give a f**k what others think of me. 
Everbody feels a litte bit anxiety at times, wheter it be alone buying grocery, waiting for the bus or something else. A human beeeing doesnt need to be super confident all the time. But one major thing that has chaged is that Im more talkative and witty when Im with friends, I can crack jokes much easier than i did before which i guess earns you respect in the shallow world that we live in.


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## euphoria (Jan 21, 2009)

I am going to quit mirtazapine and just have a high dose of sertraline. Mirtazapine blocks 5-HT2A and C, but not B. I don't trust selectively enhancing 5-HT2B because of the heart damage thing -- the only drugs linked to damage were selective to that receptor. I have been getting heart pain since starting this combo... Blocking 5-HT2A isn't something I want to do either, mirtazapine gives me too much emotional dulling. Also I don't think mirtazapine is doing much any more.


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## crayzyMed (Nov 2, 2006)

Medline said:


> Agomelatine is a melatonin agonist, 5-HT2C antagonist and therefor a norepinephrine & dopamine disinhibitor.


+1
In theorie a SSRI, agomelatine and provigil combination should be excellent...

SSRI would provide the serotonin.
Agomelatine would provide the 5HT2C antagonism wich is why the effexor and remeron combo is that good.
Provigil would provide the stimulation wich would be missing when taking the SSRI on its own.

And this combo would have less side effects too.


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## jim_morrison (Aug 17, 2008)

agomelatine augamentation of SSRI/SNRI's would certainly be interesting.


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## euphoria (Jan 21, 2009)

Agomelatine doesn't have a long enough half-life to provide 24hr blockade of SSRIs' side-effects, so I don't think I'll bother trying that.

Currently I am on 50mg sertraline (hopefully going up), 30mg mirtazapine (tapering to nothing) and 200mg carbamazepine (going up). The last one is for seizures, but apparently it can mildly help mood without too much cognitive disturbance... If I had to decide, I'd say it's made me more depressed, not less.

This heart pain has been a big concern, probably nothing but without being able to think clearly, the mind can get into some weird hypochondriasis. I want to get off mirtazapine ASAP because I don't trust this combo. I remember last time coming off it I got this big wave of emotion and started crying at anything... Meh, not worth getting attached to emotion, being on an SSRI again.


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## crayzyMed (Nov 2, 2006)

euphoria said:


> Agomelatine doesn't have a long enough half-life to provide 24hr blockade of SSRIs' side-effects, so I don't think I'll bother trying that.
> 
> Currently I am on 50mg sertraline (hopefully going up), 30mg mirtazapine (tapering to nothing) and 200mg carbamazepine (going up). The last one is for seizures, but apparently it can mildly help mood without too much cognitive disturbance... If I had to decide, I'd say it's made me more depressed, not less.
> 
> This heart pain has been a big concern, probably nothing but without being able to think clearly, the mind can get into some weird hypochondriasis. I want to get off mirtazapine ASAP because I don't trust this combo. I remember last time coming off it I got this big wave of emotion and started crying at anything... Meh, not worth getting attached to emotion, being on an SSRI again.


Your not making sense, the half life wont change a thing, serotonin levels wont suddenly change if its out your system


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## db0255 (Jul 20, 2009)

euphoria said:


> Agomelatine doesn't have a long enough half-life to provide 24hr blockade of SSRIs' side-effects, so I don't think I'll bother trying that.
> 
> Currently I am on 50mg sertraline (hopefully going up), 30mg mirtazapine (tapering to nothing) and 200mg carbamazepine (going up). The last one is for seizures, but apparently it can mildly help mood without too much cognitive disturbance... If I had to decide, I'd say it's made me more depressed, not less.
> 
> This heart pain has been a big concern, probably nothing but without being able to think clearly, the mind can get into some weird hypochondriasis. I want to get off mirtazapine ASAP because I don't trust this combo. I remember last time coming off it I got this big wave of emotion and started crying at anything... Meh, not worth getting attached to emotion, being on an SSRI again.


Remeron is a WEIRD drug. It makes me feel hungry all the time, but then it hit me at certain times of the day, and it would feel like I'd have low blood sugar and I was going to pass out. It also is weird as **** when it comes to dreams; while I was on it, I'd have a dream, every night, remember it, and it would be weird as ****, including a lingering feeling of unease as I awoke.


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## jim_morrison (Aug 17, 2008)

db0255 said:


> Remeron is a WEIRD drug. It makes me feel hungry all the time, but then it hit me at certain times of the day, and it would feel like I'd have low blood sugar and I was going to pass out. It also is weird as **** when it comes to dreams; while I was on it, I'd have a dream, every night, remember it, and it would be weird as ****, including a lingering feeling of unease as I awoke.


Yeah the dreams are crazy, I'm trying to taper down this stuff currently, because the next day lethargy is getting the best of me.


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## jim_morrison (Aug 17, 2008)

Apparently Agomelatine and the other melatonergics can lower testosterone and raise prolactin, thats a bit freaky.


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## crayzyMed (Nov 2, 2006)

jim_morrison said:


> Apparently Agomelatine and the other melatonergics can lower testosterone and raise prolactin, thats a bit freaky.


Where did you get that?


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## jim_morrison (Aug 17, 2008)

Ramelteon is a Melatonin receptor agonist with high affinity for melatonin MT 1 and MT 2 receptors. I'm going to assume that the same will apply to Agomelatine due to it's similair mechanism of action.

http://www.drugs.com/ppa/ramelteon.html

"Ramelteon has been associated with an effect on reproductive hormones in adults (eg, decreased testosterone and increased prolactin levels). It is not known what effect chronic or chronic intermittent use may have on the reproductive axis in adolescents and children."

"Consider assessment of prolactin and testosterone levels, as appropriate, for patients presenting with unexplained amenorrhea, galactorrhea, decreased libido, or infertility."


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## crayzyMed (Nov 2, 2006)

Not sure wheter that would apply to agomelatine, i'm interested in agomelatine anywhay for its benefits. even if it doesnt work for my anxiety.


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## jim_morrison (Aug 17, 2008)

crayzyMed said:


> Not sure wheter that would apply to agomelatine, i'm interested in agomelatine anywhay for its benefits. even if it doesnt work for my anxiety.


Most likely would as these symptoms are believed to be mediated via MT 1 and MT 2 receptor agonism which is a property shared by agomelatine.

I believe rocknroll made a good post awhile ago regarding the relationship between the pituitary gland, melatonin and it's roll in regulating growth hormone.

Edit; see referal too "Does prozac stunt growth" thread.


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## crayzyMed (Nov 2, 2006)

jim_morrison said:


> Most likely would as these symptoms are believed to be mediated via MT 1 and MT 2 receptor agonism which is a property shared by agomelatine.
> 
> I believe rocknroll made a good post awhile ago regarding the relationship between the pituitary gland, melatonin and it's roll in regulating growth hormone.


That still for me isnt a reasen to dismiss this med, i like rocknrolls posts and i'm also theorizing like him for coming up with an awesome med stack.

5HT2C antagonism + 5HT1A agonis + 5HT1A autoreceptor antagonism = :boogie

I refuse to take remeron as its an H1 antagonis and has mild serotonin reuptake properties.


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## jim_morrison (Aug 17, 2008)

crayzyMed said:


> That still for me isnt a reasen to dismiss this med, i like rocknrolls posts and i'm also theorizing like him for coming up with an awesome med stack.
> 
> 5HT2C antagonism + 5HT1A agonis + 5HT1A autoreceptor antagonism = :boogie
> 
> I refuse to take remeron as its an H1 antagonis and has mild serotonin reuptake properties.


I'm not suggesting that you shouldnt take it, was just pointing the growth hormone thing out.

Btw Remeron has clinically negligible serotonin reuptake properties, it's thought to mediate serotonin release via alpha-2 adrenergic blockade.

The H1 antagonism is pretty strong though, coupled with remerons long half life it makes for some serious daytime lethargy, for me atleast.


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## crayzyMed (Nov 2, 2006)

jim_morrison said:


> I'm not suggesting that you shouldnt take it, was just pointing the growth hormone thing out.
> 
> Btw Remeron has clinically negligible serotonin reuptake properties, it's thought to mediate serotonin release via alpha-2 adrenergic blockade.
> 
> The H1 antagonism is pretty strong though, coupled with remerons long half life it makes for some serious daytime lethargy, for me atleast.


Yeah thats a serieus issue, considering i'm also into "nootropics" and supplements that boost my energie, i dont want it all to go the waste because of remeron.


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## euphoria (Jan 21, 2009)

Okay, my latest goal is to keep going up with sertraline. That still doesn't fix my anhedonia, so I'm going to ask my psychiatrist and/or neurologist what can be done about that. I have a bad feeling they will suggest aripiprazole or methylphenidate, two drugs I have no intention of ever taking (because of various reasons). I will ask them if I can try a dopamine agonist for anhedonia, there is plenty of evidence for this use (SSRI augmentation).

Further into the future I may consider enquiring about buspirone, but only if sertraline + pramipexole + carbamazepine doesn't work...


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## euphoria (Jan 21, 2009)

Music sounds somehow lower than before, now I think about it. Could be carbamazepine....


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## siddyrocks (Jun 20, 2011)

Hi all. Sorry to revive this thread in case nobody's interested&#8230; I've started medicinal treatment after eight years of untreated depression. I'm from Canada, if that changes anything, though I'm currently in the US. I have a background in medicine - though certainly am *NOT a doctor, nor a substitute for one* _[Insert obligatory disclaimer here]_. I believe in logic over all else, which so far is the only reason I haven't committed suicide.

the Background _(those uninterested can skip to the Bottom Line)_

My doctor prescribed me sertraline. 50mg at first _(Nov)_, but he sent me on my way to last 3 months at 100mg _(as I was to be away from Canada and hadn't yet told anyone in my family and have little money not watched by said family)_, said that I can call him at home if I wanted, and could up the dose to 100mg if I saw fit. So I did after 2 months of nothing but nausea _(Jan)_.

I stayed at that dose for 5 months to no avail _(but still daily nausea)_ at which point _(May)_ I went for a visit back home _(and told all my family to mixed pity and offense - I don't know which was worse)_. I payed the doctor a visit and he suggested I give mirtazapine a look. It seemed harmless enough, so he wrote me a prescription. We agreed to wean up to 30mg, but he gave me enough for 45mg until August.

the Known

Chemically, it will vary between choice of SSRI (assuming we're holding the mirtazapine constant), but so long as the chemical pathways of action don't outright cross, biochemically and neurochemically, mirtazapine or any NaSSA taken with any SSRI should be okay. In fact, it's often indicated clinically, as the mirtazapine effectively treats the chronic seratonin syndrome induced by the sertraline. Further, as a receptor antagonist, it prevents receptor depopulation in light of said seratonin syndrome, decreasing dependance and withdrawal symptoms of sertraline.

_To use an analogy, in my understanding, it's like two people at the opposite ends of a paper cup telephone. Depression of my sort (and yours if you're taking either of these drugs) is when, for whatever reason, Person B can barely hear Person A. Sertraline is like Person A yelling. But this might just get too loud for Person B and she might start getting deaf - seratonin syndrome. Enter mirtazapine [yes, I am imagining it with a cape in a heroic pose], or earplugs for Person B. So now Person A is yelling his head off and Person B, she is saying "I can't hear you!" and you feel&#8230; just about the same as you used to. Maybe a little better, maybe a little worse, it's a personal balance. But the truly important thing is Person A thinks Person B can't hear him, so he gets used to screaming louder and louder. And Person B still can't hear A, so her hearing gets better and better. And one day in the apparently bright future, when you taper them both, A is yelling himself sore and B can hear a pin drop and euphoria greets you._​
the Bottom Line

So right now I'm on 30mg mirtazapine and 100mg sertraline and have been since May. The mirtazapine works lovelily at quelling the nausea, as it is a selective receptor antagonist. It also does a job on the insomnia _(various mixed forms)_ - you can practically see my writing becoming less eloquent as I go, hah. Still, on 30mg, I feel fine come the morning, though I do like to keep the morning hours to myself, pretending to sleep in, but reading or doing kakuro _(my latest internet addiction)_ or playing with my SLR. I have a little OCD which personally I like, and luckily, it remains unaffected. As far as social anxiety, I have no friends here and pretty much live in the hospital where I work, so it's hard to say. But while I normally go faint, tremble and sometimes black out _(but am still conscious)_ when meeting new people, all but the trembling seems to be gone. It's been a month since my last suicidal urge. All seems good and well, though the improvement may be a consequence of dropping out of school for a year.

That's my situation, anyways. If anyone shows interest, then I'll leave updates on how things progress for me. And I'd love your input, as I am as lost as I once found myself at the ripe age of two in West Edmonton Mall, haha.

PS. I heard mention of dopaminergic drugs. I'll admit, I have a personal bias in regards to this. My grandfather was bipolar and was treated when I was far too young to understand this stuff, with some dopaminergic drug or another. In any case, while it levelled his mood, dopamine is also an important neuroreceptor in fine motor control. He got medicinally-induced Parkinsonian symptoms, which were ultimately the cause of his death [suffocation]. Personally, I'm steering well clear of them.


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## banks76 (Aug 15, 2013)

*SSRI and SNRI Mindfull*

On 50mg of Steraline 10mg diazepam and 45mg of Mirtazapine. and to be honest feel really foggy and forgetfull as hell and hard to do anything.


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## mikoy (Aug 12, 2010)

Mirtazapine with SNRI work in synergy becouse alpha-2 antagonism (antagonism of alpha-2 autoreceptors and heteroreceptors) + SNRI. It should work better that mirtazapine+SSRI becouse of NRI component of SNRI. It's working by increase in dopamine in prefrontal cortex (PFC). Lab test confirms this - dopamine increase is larger with alpha-2 antagonist + duloxetine than alpha-2 antagonist + fluoxetine.

"Alpha2-adrenergic receptor blockade markedly potentiates duloxetine- and fluoxetine-induced increases in noradrenaline, dopamine, and serotonin levels in the frontal cortex of freely moving rats"

http://www.ncbi.nlm.nih.gov/pubmed/9375697

If someone ccan not tolerate sedating effects of mirtazapine, buspirone should act in similar way (buspirone metabolite 1-PP is alpha-2 antagonist in strenght 40 nm in Ki - mirtazapine strenght is 20 nm in Ki).:

"Buspirone enhances duloxetine- and fluoxetine-induced increases in dialysate levels of dopamine and noradrenaline, but not serotonin, in the frontal cortex of freely moving rats"

http://www.ncbi.nlm.nih.gov/pubmed/9048781


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## UltraShy (Nov 8, 2003)

California Rocket Fuel would never have topped Parnate had any reasonable dose been used. As I recall, the median dose of Parnate was a pitiful 39 mg. Had Parnate been used at 120 mg (which is perfectly safe -- I've used up to 200 mg), I have no doubt that Parnate would have kicked the a** of any other antidepressant.

Anyone delusional enough to think these modern ADs are efficacious should read the following:

http://www.psychotropical.com/why-most-new-antidepressants-are-ineffective

Remeron will make you fat & tired. SSRIs can't reliably cure anything other than premature ejaculation. Now that SSRIs patents have all expired Big Pharma is wildly promoting atypical antipsychotics that will make you fat and put you at risk for diabetes.

Is there anybody here who eagerly wants to become a diabetic? In a nation where 1 in 3 adults is obese, is there anyone who thinks we need a drug that will further super-size the nation? If so, you are indeed psychotic and an atypical antipsychotic may actually be justified for you.


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## mikoy (Aug 12, 2010)

Good for you becouse you can use old maois.


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## UltraShy (Nov 8, 2003)

mikoy said:


> Good for you becouse you can use old maois.


Don't they have MAOIs in Poland?

MAOIs aren't magic. Just read my recent post about how due to Nardil I'm totally full of crap: http://www.socialanxietysupport.com/forum/f30/i-m-totally-full-of-crap-1545146/


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## mikoy (Aug 12, 2010)

Yes, we have one mao - moclobemide...


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## UltraShy (Nov 8, 2003)

mikoy said:


> Yes, we have one mao - moclobemide...


I'm sorry to hear that you don't have access to "real" MAOIs.

Though I personally don't think MAOIs would be needed nearly so much if Dr. Wussy P***y would prescribe benzos in adequate amounts. Though we live in an era where treating anxiety with an anti-anxiety drug is deemed a wild & crazy idea. Typical benzo doses are woefully inadequate due to hysterically exaggerated fears of "addiction."

I have no idea what the drug laws are in Poland, but in both the US & UK one can *LEGALLY* buy all the benzos they want with no prescription needed. Just look into research chemicals like diclazepam, which is an analog of Valium as just one example.


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## mikoy (Aug 12, 2010)

The problem in my area is that many docs are uniformed and ignorant. My main idea of post was that SNRI+mirtazapine should work better than SSRI+mirtazapine, and mirtazapine could be replaced by buspirone.

Benzos in Poland are only on prescription. Lack of old maois are one problem - another is that for ADD/ADHD we have only methylphenidate.


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## UltraShy (Nov 8, 2003)

mikoy said:


> The problem in my area is that many docs are uniformed and ignorant. My main idea of post was that SNRI+mirtazapine should work better than SSRI+mirtazapine, and mirtazapine could be replaced by buspirone.
> 
> *Benzos in Poland are only on prescription.* Lack of old maois are one problem - another is that for ADD/ADHD we have only methylphenidate.


I readily found a UK company -- www.rapidchems.com -- that ships to Poland. And they sell diclazepam, the Valium analog I mentioned, in quantities of up to 50,000. Do you think 50,000 pills will be sufficient to meet your needs?:grin2: They sell numerous other benzos as well.

The idea you need a scrip is a total myth, believed by 99%+ of the population. These are research chemicals, so legally they're not even drugs, so long as they keep up the pretense that they most definitely are NOT for human consumption. Yeah, I'm sure everyone is feeding them to their nervous dog to study the effects.


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## watertouch (Nov 4, 2013)

@*mikoy* Yeah we only have Aurorix/moclobemid in Sweden as well... 
To get my MAOI-Parnate i have to get a special licens approval from the Swedish MPA (Medical Products Agency)+ a prescribtion from the Dr... I can then go to my Pharmacy and they can import it.

It kinda was the same with methylphenidate and Amphetamine...(it still is for Amphetamine for adults, i have from my last Dr before he left a prescribtion for a couple 100 pills DexA IR, but no licens approval :mum)( I was in his room when he called MPA, and checked and said "was there anything else...."No they said", So he went: It gonna go fast now like a week probably.

Well he had missed some little box i think to get it approved but since he left the clinic, the receptionist would not give out his phonenumber, or forward a message (F Bxtch). 
Altough im getting transfered to a Dependence-clinic for my excessive drug use...

They have this "new" Elvanse or Vyvanse/lisdexamphetamine that doesn't require a licens, but a Pdoc needs to prescribe it, its C-II narcotics... And Ritalin/methylphenidate does not require a licens either....

But its only for ADD/HD and "ok"/off label for narcolepsy.

We actually have a "new" version same as the old DexA IR, 
Attentin (dexamfetaminsulfate) But its only for ages 6-17... So my Pdoc could not prescribe it.:|.

I hate being "stuck between the chairs"... And nobody really cares... The story of my life, sometime i wish i would have never sought out help from the Psychiatry some 12years ago.


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