Lexapro + Remeron (+ maybe Wellbutrin)

[ParanoidAndroid]

Hello, it's my first post here.

My pdoc currently has me on Lexapro 10 mg and Remeron 30 mg, for anxiety and depression that was kicked off by losing a family member, but also stemming from major transitions (moving to a new state, starting a new job...) and just general angst about life. I've been on the Remeron a month, and the Lexapro two weeks. Clonazepam 0.5 mg prn, which is usually one or two times a day.

The Remeron is great for sleep, and I know from using it in the past the Lexapro should help with anxiety. I'm jogging every day, eating lots of flax and fish oil, and trying to stay involved in meaningful activities, but I'm not quite feeling the fog, and broken record of unwelcome thoughts, lift the way I'd like. Perhaps I need to wait longer, but I am anxious to feel normal again.

Was thinking of discussing adding Wellbutrin with the pdoc. Has anyone tried this combo? Is three antidepressants a crazy drug regimen?

Thanks,

Marvin

[Lasso]

Personally, I would wait a month, then if you are not feeling better you can increase either Lexapro or Remeron or both.

Stay on the increased dosage a month, THEN you can start to think of adding another med.

Ofcourse this is all up to you and your doc.

[ParanoidAndroid]

OK, thanks for the encouragement, I'll hang in there!

[ParanoidAndroid]

OK, week 3 on the Lexapro and I am having a tough time on it. Strange (bad) dreams, night sweats, anxiety during the day, not being able to tell what temperature my body wants to be at, somewhat irritable, smells seem unusually intense. I really freaked out the other day (inwardly), I felt my grip was slipping. However, we had a heat wave here (104 F) and I think everyone felt like that.

On the other hand I can see a certain good that it's doing, maybe, in stopping the broken record thoughts. Maybe that's the positive effect it's having on me - it's allowing me to see the good in things such as being on Lexapro...

I really don't know if I can stand the skeeved-out side effects. Maybe in combination with the Remeron I'm hitting my serotonin too hard.

Another thing is I switched a week ago from Klonopin to Xanax because I thought the former was actually contributing to depression, which I still think is true, but maybe the switch has caused some discombobulation.

Anyway I get to talk about all this good stuff with my pdoc next week.

[DannyBoy]

I didn't realize you could add Remeron to Lexapro. I've been needing a second AD for my depression. Been leaning more towards Wellbutrin, gonna ask my pdoc this week.

[conundrum]

It is an interesting combo and it should work synergistically, in theory. SSRIs increase serotonin to all of the serotonergic receptors. When serotonin activates some receptors it helps with anxiety and depression. When other receptors are activated it can cause side effects like sexual dysfunction, initial anxiety, and nausea.

Taking remeron blocks the receptors that cause some side effects and force them to work in a reverse manner, which increases other feel good chemicals in certain areas of the brain and prevents insomnia, nausea, and sexual dysfunction. And then by blocking the bad receptors it should direct more serotonin go to the good receptors that help with mood.

The main downside I can see with a lexapro and remeron combo is that they both can cause weight gain. With a lexapro wellbutrin combo, the stimulating effect of wellbutrin could curb some of the weight gain that lexapro can cause.

[rowen]

Hang in there. The side effects should ease up in a few more weeks.

I was on Remeron and Lexapro. It pulled me out of a dark depression, but my pdoc wasn't happy with the weight gain. I didn't gain weight from Lexapro alone, but Remeron had me eating like crazy! It was kind of hilarious, actually.

On a cocktail that works right now, so it's most definitely possible. Looking forward to hearing updates from you.

[ParanoidAndroid]

Thanks. Weight gain is not a problem for me, I've actually lost weight from the stress, which seems to kill my appetite. I get the munchies on Remeron alone but less so on the cocktail.

I'm about fed up with all the sweating. I think I may also be clenching my jaw. Also a bit of tremor in the hands.

We'll see how it goes.

[ParanoidAndroid]

I'm off the Lexapro, just on the Remeron now. We are going to go up on the Remeron, to 45 mg to see if that helps. If not, we will go back down and then think about options. So this is no longer really a "cocktails" discussion.

[nibblerd]

It is an interesting combo and it should work synergistically, in theory. SSRIs increase serotonin to all of the serotonergic receptors. When serotonin activates some receptors it helps with anxiety and depression. When other receptors are activated it can cause side effects like sexual dysfunction, initial anxiety, and nausea.

Taking remeron blocks the receptors that cause some side effects and force them to work in a reverse manner, which increases other feel good chemicals in certain areas of the brain and prevents insomnia, nausea, and sexual dysfunction. And then by blocking the bad receptors it should direct more serotonin go to the good receptors that help with mood.

The main downside I can see with a lexapro and remeron combo is that they both can cause weight gain. With a lexapro wellbutrin combo, the stimulating effect of wellbutrin could curb some of the weight gain that lexapro can cause.

Couldn't an SSRI decrease mirtazapine's efficacy because of the increased serotonin hanging around the brain, cloggin up the receptors?

[conundrum]

It is an interesting combo and it should work synergistically, in theory. SSRIs increase serotonin to all of the serotonergic receptors. When serotonin activates some receptors it helps with anxiety and depression. When other receptors are activated it can cause side effects like sexual dysfunction, initial anxiety, and nausea.

Taking remeron blocks the receptors that cause some side effects and force them to work in a reverse manner, which increases other feel good chemicals in certain areas of the brain and prevents insomnia, nausea, and sexual dysfunction. And then by blocking the bad receptors it should direct more serotonin go to the good receptors that help with mood.

The main downside I can see with a lexapro and remeron combo is that they both can cause weight gain. With a lexapro wellbutrin combo, the stimulating effect of wellbutrin could curb some of the weight gain that lexapro can cause.

Couldn't an SSRI decrease mirtazapine's efficacy because of the increased serotonin hanging around the brain, cloggin up the receptors?

Maybe, I don't know. I know it is often combined with other drugs including SSRIs and SNRIs. Also there is a drug called cyproheptadine that blocks those same serotonergic receptors and it is used to treat serotonin syndrome, which can happen when you take too many serotonergic drugs.