SSRIs don't like me. Remeron pooped out. Now what?

[snowstormburning]

I started taking Remeron this January. I had pretty severe insomnia, so my pdoc started me on 7.5 mg. It helped with the sleep right away, gave me an appetite within a week, and lifted my depression within two weeks. I was amazed. (the following is me rambling about how awesome my life was on Remeron and can be skimmed or skipped altogether if you aren't interested) I'd been depressed for so long that I forgot what it was like to feel good. I didn't spend entire days staring at the ceiling thinking about hanging myself anymore. I could function and contribute to society. I could socialize--and enjoy it. I could have fun. I found that I could be attracted to people again, and discovered that I was a sexual being after all (though I didn't exactly start gettting laid every night, mind you). Food tasted better. I gained the weight that I've been trying to gain for years. I stopped cutting. The side effects were minimal; I eventually had to up the dose to 15mg so I wouldn't sleep for 18 hours a day, but other than that I had few problems. Remeron was like some sort of miracle drug for me. I was completely happy to be alive for the first time in years, and I couldn't believe it.

Then it stopped working.

I noticed things start to change this past Thursday. I woke up in the morning, and I felt depressed. But as the day went on, I felt fine. Same thing happened on Friday, but I felt normal again within a few hours. On Saturday, I felt so depressed when I woke up that I stayed in bed for about four hours, finally got out of bed around mid-afternoon, and didn't feel normal again until 8:00 at night. That night, I couldn't fall asleep until around 3 AM, and only did fall asleep after I SIed for the first time since Remeron kicked in. Today, I have been depressed nearly all day, I have no appetite, and I can't fall asleep. I've been snapping at everyone and crying for no reason. I'm nearly right back to where I started, only worse, because now I know what it's like to be normal. Now I actually know what I'm missing, and how much depression really does suck.

The only other antidepressants I've tried are Prozac and Celexa, and we do not get along well. Trust me, I'm not your typical average Joe who's whiny about getting fat and not being able to have sex. SSRIs gave me some awful and moderately strange side effects, especially Celexa. Prozac didn't do much for me at all. No effect on sleep, no effect on appetite, no effect on mood. Just SEVERE constipation (I was in constant pain, and couldn't have any sort of bowel movement without the use of a laxative) and moderate dizziness (I couldn't stand up without feeling like I was going to pass out; walking was difficult and driving impossible). I stuck with it for five weeks with no improvement in mood, and finally my pdoc and I gave up on it and switched to Celexa. That was much worse. Still constipated, but on top of that, I had a constant 100-102 degree fever, chills, general achy flu-like symptoms, constant nausea and occasional vomiting, severe dizziness (I could barely walk and fainted frequently), and my insomnia and lack of appetite became much worse (the mere thought of food disgusted me and I had to force myself to eat; I was awake for up to three days at a time, would sleep for two or three hours, than would be awake for three more days, etc...). Oh, and peeing was exceptionally painful and my urine had a strange odor to it (I was tested for a UTI and a yeast infection and they didn't find either, so Celexa was the only thing left to blame). I went off it after two weeks, and after that experience my pdoc and I both decided not to try any more SSRIs.

Now that Remeron seems to be pooping out, I'm wondering what my other options are. I haven't contacted my pdoc yet, but I plan to do so soon. Although she is certainly my number 1 source of information and advice, I'd like to get a second opinion from people who've actually dealt with this kind of stuff first hand. Should I up the dose of Remeron? Will that help at all, or will it be a fruitless endeavor? Has anyone else dealt with the Remeron poop out? If so, did any other meds help you after that? Since Remeron is really the only drug of its class available here, it's not like I can just switch to another similar medication. Will I have to go on a bunch of different meds to get a similar effect? I've read that people who responded to Remeron also tend to respond well to MAOIs. But those scare me a little, what with all the dietary restrictions and the risk of hypertensive crisis. Are they really as bad as they sound? TCAs are another option, of course, but I can't imagine how I would get along with them given my crazy reaction to SSRIs, or at least Celexa. Should I try some other SSRIs before looking at other meds, or am I right in wanting to avoid them?

Any input would be helpful. Sorry this is so long!

[bluelikejazz]

Remeron is know for its fast poop-out rate. If it makes you feel better I felt amazing for two and a half weeks before I crashed very, very hard into the pit again.

Because you responded so well to a low dose they might try you on 30 or 45mgs, after that it's up to your pdoc. I had bad side effects on ssris to, and pdoc wanted to try Aurorix (an MAOI, but it's reversable so not as many interactions), or Mianserin but we went with amitryptaline instead.

There are lots of other drugs, I think the TCAs are similar to Remeron. I'm looking at the brief flight to health as little reprieve to remind that sometimes life is worth living, and if I made it out (even for two weeks) I can do it again.

Anyway, welcome to the boards. Hopefully you can find your way back to feeling good.

[tryp]

Remeron crapped out on me - I started at 30 mg, which helped me after a couple months, then I got really depressed again, pdoc upped it to 45 mg, which may have helped a tiny bit, but not enough, and after this week, I'm probably moving on to SSRIs.

If Remeron has been a good drug for you with few side effects, it might be worth upping the dose, especially since you said you can't handle SSRIs - you might as well try it.

[AnneMarie]

If it was me, I'd first try raising Remeron. If that doesn't do it or last, I'd give at least one more SSRI a chance since Remeron works on serotonin. Lexapro is supposed to have a low side effect profile. Not sure, but I think Zoloft works more differently than the others. (Each works differently.) There also is Wellbutrin, but it works on dopamine which may or may not help. I'd suggest holding off on the SNRIs (Effexor, Pristiq, Cymbalta) until you try the others since these work on two neurotransmitters and why go there if you can solve the problem only playing with one. Beyond that there are many other options including old school tricyclics which work well for some, mood stabilizers, supplementing with Lithium, etc, etc. Odds are very high you'll find something that works long before then.

The best advice and the most important advice is to work closely with your doctor. None of us know you and we don't have licenses to practice. Also, if you are working with a GP and continue to have problems finding the right med, see a psychiatrist, the MD who specializes in head meds.

[snowstormburning]

Thanks for the replies, everyone! You've all been quite helpful. I've contacted my pdoc, but she hasn't gotten back to me yet. Her secretary isn't exactly the most organized young lady in the world; it often takes her days to even tell my pdoc I called, if she does. *sigh*

Anyway, I've been feeling about the same, but not as bad as I felt before Remeron. I feel awful, but I can still function, even at my job at a preschool (let me tell you, before Remeron, there was no way I could chase after four-year-olds all day!). I haven't been eating or sleeping as much, but I'm getting by.

Since I'm still getting a partial response out of Remeron, I'm hesitant to go off it. When it comes time to see my pdoc, I think I'll ask her to up the dose or maybe augment it with something.

bluelikejazz: What kind of side effects did you get from amitryptaline? Were they better or worse than SSRIs? Thanks for the welcome, by the way.

[bluelikejazz]

When I started lexapro I had constant, intrusive suicidal ideation. The cymbalta (snri) wasn't so bad, but I had indigestion pain so severe that I couldn't eat for days. I was on a very high dose (120mg) and even that didn't work, so I gave up on it.

The Remeron was good at 15mgs, but once it got up to 45 it caused more anxiety. I've only had really minor side effects (constipation, a little dizzyness) but I am only on a tiny dose.