Remeron for mild/moderate or severe depression?

[Klaein]

I have heard left and right that Remeron is indicated for the more serious types of depression rather than something mild like dysthymia (my type of depression).

Funny thing is my pdoc says he uses it only for mild to moderate depression. Can it help dysthymia or would it be overkill? Perhaps keep the dose low?

Is my pdoc full of shit?

thanks

[CrazyCatLady]

My husband was on it (until he lost his insurance) for moderate depression. He really liked it and said it made him feel so much better.

[tryp]

To be honest, I did really well on Remeron when I was only mildly depressed, but as soon as I really went downhill, it just couldn't cut it and I had to switch to an SSRI.

It's really good for depression + anxiety though.

[mudpuppy]

I don't really think Anti-depressants work that way. I don't think you can say that drug x works for mild depression and drug y works for severe depression.

You can only say that drug x works for this person, or doesn't.

Anti-depressant wise, you can't really find an anti-depressant that is "overkill".

You can find yourself in a situation where the side-effects or restrictions associated with an anti-depressant have more of a negative impact than the depression itself did. This is especially true of drugs like MAOIs, which is why they are typically reserved for when all other treatments have failed.

Certain drugs are also known for being more effective on treatment resistant depression, but again, that doesn't relate to the severity of the depression, it relates to how well it responds to medication. It could be "mild" depression that has not responded to multiple medications of different classes.

Remeron is increasingly more popular with many pdocs for a few reasons.

One, it can double as a sleep med, which means less medications rx'd to a patient. Less pills = higher likelihood of med compliance, and it saves the patient money.

Two, it tends to begin working faster than some other anti-depressants.

Three, it doesn't interact with many other medications, which makes it easier to add to combination therapies, or for people who take medications for unrelated ilnesses.

[rowen]

Remeron is nice for more severe depression for one of the reasons mud listed - it works faster. But honestly, like mud said, an AD is an AD.

But if your depression is mild, maybe therapy would be a better option than taking meds, anyway. Unless it's more chronic and annoying, in which case an AD won't hurt.

[Maceo]

I was taking it in addition to Effexor to help me sleep. I was severely depressed but the Remeron did not help with that. My guess is that they would reserve it for more severe cases because it's side-effect profile sucks compared to say Prozac. It is really sedating and causes sugar/carb craving and hence weight gain.

[Guest mantra]

I don't think you can say that drug x works for mild depression and drug y works for severe depression.

Yep, that's how I understand things.

Remeron is usually considered a second-line antidepressant, after the usual suspects like SSRIs and SNRIs. So that may be where severity comes in--it's something to try after other classes haven't worked. Just a theory

Compared to the joys of SSRI-induced akathisia and Parkinsonism, I'll take sleepiness and munchies any day I'm not surprised to hear it's becoming more popular.

[Guest Jonathan]

I respond well to 30mg remeron as an AD for my bipolar 1 depression. SSRI's send me into crazy dysphoric mania. In my case I have had a very low side-effect profile. A little morning hangover, but considering my seroquel and depakote that's to be expected. Doesn't interact with my other meds for crohns disease. If you get the munchies on seroquel adding remeron might create a big weight gain issue though.

[nibblerd]

This is especially true of drugs like MAOIs, which is why they are typically reserved for when all other treatments have failed.

Ah, thank gob for the discovery of the RIMA! One such reversible MAOI (type B, moclobemide) does not require a change in diet and does not require a 2 week wash. The downside is that it requires more doses to be taken.

[SashaSue]

I believe they're also significantly less effective than traditional MAOI's, no?

[nibblerd]

I believe they're also significantly less effective than traditional MAOI's, no?

Why would they be?

[mudpuppy]

The few studies that were done in the US showed efficacy about comparable to SSRIs and TCAs, and less effective than traditional MAOIs.

http://www.nature.com/npp/journal/v20/n3/full/1395258a.html

[nibblerd]

The few studies that were done in the US showed efficacy about comparable to SSRIs and TCAs, and less effective than traditional MAOIs.

http://www.nature.co...l/1395258a.html

Thanks for the link. That's a tiny difference, and I doubt it's because of their selectivity or the reversibility.. Such a small difference in efficacy is probably overwhelmed by the lower risk of hypertensive crisis.