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Old 09-26-2009, 05:28 PM   #1 (permalink)
 
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Default SSRI/SNRI + mirtazapine (Remeron) combination -- too optimistic? Experiences please.

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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Old 09-26-2009, 07:18 PM   #2 (permalink)
 
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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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Old 09-26-2009, 09:11 PM   #3 (permalink)
 
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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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Old 09-26-2009, 10:14 PM   #4 (permalink)
 
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Originally Posted by britisharrow View Post
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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Old 09-27-2009, 06:08 AM   #5 (permalink)
 
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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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Old 09-27-2009, 11:16 AM   #6 (permalink)
 
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Being on Prozac and Remeron is like having a jackhammer to my frontal lobe....just a thought.
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Old 09-27-2009, 11:35 PM   #7 (permalink)
 
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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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Old 09-28-2009, 11:01 AM   #8 (permalink)
 
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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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Old 10-02-2009, 08:21 AM   #9 (permalink)
 
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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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Old 10-02-2009, 11:18 AM   #10 (permalink)
 
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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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Old 10-02-2009, 08:40 PM   #11 (permalink)
 
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Sounds cool euphoria, don't I recall you saying that zoloft + mirtazapine once gave you a seizure though??
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Old 10-03-2009, 12:38 AM   #12 (permalink)
 
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I remember that too, here it is:
Quote:
Originally Posted by euphoria View Post
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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Old 10-03-2009, 01:32 AM   #13 (permalink)
 
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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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Old 10-03-2009, 01:36 AM   #14 (permalink)
 
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Quote:
Originally Posted by Medline View Post
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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Old 10-03-2009, 01:55 AM   #15 (permalink)
 
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Quote:
Originally Posted by jim_morrison View Post
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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Old 10-03-2009, 02:08 AM   #16 (permalink)
 
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Quote:
Originally Posted by euphoria View Post
Where is that post from?
http://www.socialanxietysupport.com/...azapine-65203/
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Old 10-03-2009, 09:04 AM   #17 (permalink)
 
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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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Old 10-03-2009, 11:34 AM   #18 (permalink)
 
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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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Old 10-03-2009, 11:41 AM   #19 (permalink)
 
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Quote:
Originally Posted by euphoria View Post
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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Old 10-03-2009, 11:44 AM   #20 (permalink)
 
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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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