Social Anxiety Forum - View Single Post - What does mirtazapine (Remeron) feel like once you're used to the sedation?
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post #12 of (permalink) Old 08-01-2013, 09:24 PM
joetrader
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Join Date: Aug 2013
Posts: 1

Trimipramine Better than Mianserin (IMHO...)


I never could shake the excessive sedation with the Remeron/Mianserin family of ADs, not even at 6 weeks. And the antidepressant effect was only modest (much less than what I'd been led to believe) so I did not stay with this med. Like you, I too wanted a more "activating" AD, not the zombie-"night of the living dead"-type stuff that makes up much of the modern SSRI complex. In this regard, I tried both desipramine and protriptyline (two old norepinephrine-oriented TCAs) with some success, but the agitation and insomnia was too much on the former, and the excessive drying effects were intolerable in the case of the latter. Finally I tried another older tricyclic called trimipramine (Surmontil, Rhotrimine) and let me tell you -- THIS med worked like magic!! Very strange...it was extremely sedating for the first couple of weeks, so I only took 25 mg at bedtime initially. But then the daytime sedation got a lot better after about 4 weeks, though it still knocks me out at night. I'd call the full-blown trimipramine state (which I define as achievable by taking 25-50 mg per night for at least 4 weeks) to be one of calmness and clarity, but with a great deal of energy and motivation as well. Very unique as modern ADs go -- I've tried over 20 of them (new and old) and no antidepressant so far even comes close to trimipramine in terms of effectiveness for anxiety, depression, and chronic neuropathic pain, which was my main reason for taking ADs. It also completely stopped my long-term migraine headache cycle, which I never thought would be possible. Interestingly, they don't even understand how or why trimipramine works. It's the only TCA that doesn't significantly affect serotonin or norepinephrine! Don't believe any online sites that tell you otherwise, because they are just parroting standard tricyclic spiel if they claim that 5HT or NE are potentiated...they definitely are not. Trimipramine is believed to work primarily via it's inhibitory action on neuronal calcium channels, but also perhaps through it's effects on the endogenous endorphin system. And the story gets even weirder, because trimipramine also has atypical antipsychotic effects (!!), thanks to it's chemical similarity to a neuroleptic drug known as clozapine. Unlike the latter, though, trimipramine doesn't carry any risk of tardive diskenesia. Finally, it's one of the most "cardiac-safe" tricyclics known, causing fewer arythmias and less tachycardia than many other TCAs. In short, I'd say that trimipramine was everything I WANTED in mirtazepine, but couldn't get from that drug. It's something different, and may be worth a try.
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