Suggestions please?

[Ophelia12]

I've been using Remeron for a couple weeks. The 15 mg made me so tired that I wasn't functional. My doctor told me to go ahead and go up to 30 mg. It's a little better, but still causes daytime drowsiness. It seems like it's working on my depression though. I'm wondering if there's another TCA that I may have less problems with, or if there's something I can add to the Remeron to counteract the drowsiness.

I don't tolerate SSRI's. We tried several of them, which caused horrible side effects for me, and that's why we moved onto TCA's. I also have IBS-D so anything with a high possibility of causing diarrhea may not be a good option. My GI doc actually recommended TCA's because they can be constipating.

I have depression, OCD and anxiety. The only other med I'm taking is Xanax 0.25 mg prn. I was taking Temazpam 15 mg also for insomnia, but obviously I haven't needed that since starting the Remeron. The last couple antidepressants I tried had caused insomnia. I also take Levsin, Zofran, Flonase and Claritin daily.

My doctor wants to be able to find something that I can tolerate, that is not addictive. She only wants me taking Xanax until we find a good regimen. I'm not opposed to taking more than one med if it works for me, and I can tolerate it.

[tryp]

There aren't really any other medications that are quite like Remeron - as far as I know, it's in its own class, as it is a tetracyclic. The only other "TCA"s are tricyclic and a class of their own. You could certainly try them though - amitriptyline is still used and there are others as well.

In terms of counteracting the drowsiness, it is a bit of a balancing act with depression + anxiety because the more activating antidepressants can cause your anxiety to skyrocket. There is Wellbutrin - it made me quite anxious, but it doesn't have that effect on everyone.

[crtclms]

I am not sure about your GI's theory that TCAs will make you constipated, therefore you should take them. You can't count on a side effect that way. I was unable to handle TCAs because they screwed up my mood, but I never was the least bit constipated.

I second Wellbutrin. I've been using it a long time, and while it *may* (or may not) be pooping out, that is after 20+ years. If you have seizures, it is not a good choice, as it lowers seizure threshold.

When you say your doctor wants you on something non-addictive, is she talking about benzos? Please look at the pin at the top of the Benzos section on the difference between physical dependence and addiction.

A lot of people on CBs, myself included, take benzos long term. I have never taken more than prescribed, and in fact usually have a bunch of prns left over. So at this point, I have a couple of months extra Xanax. I was put on my current dose 6 years ago, and have never needed an increase. I take it for GAD.

You will be dependent on almost any psychiatric medication you take. Dependence is not the same as addiction.

And there is no way you are going to develop an addiction at .25mg of Xanax prn, unless you abuse it. Temazepam is a benzo, too, btw.

There are a lot of options still left to try.

[bpladybug]

would Lamictal be a possibility?

[Ophelia12]

I am not sure about your GI's theory that TCAs will make you constipated, therefore you should take them. You can't count on a side effect that way. I was unable to handle TCAs because they screwed up my mood, but I never was the least bit constipated.

I second Wellbutrin. I've been using it a long time, and while it *may* (or may not) be pooping out, that is after 20+ years. If you have seizures, it is not a good choice, as it lowers seizure threshold.

When you say your doctor wants you on something non-addictive, is she talking about benzos? Please look at the pin at the top of the Benzos section on the difference between physical dependence and addiction.

A lot of people on CBs, myself included, take benzos long term. I have never taken more than prescribed, and in fact usually have a bunch of prns left over. So at this point, I have a couple of months extra Xanax. I was put on my current dose 6 years ago, and have never needed an increase. I take it for GAD.

You will be dependent on almost any psychiatric medication you take. Dependence is not the same as addiction.

And there is no way you are going to develop an addiction at .25mg of Xanax prn, unless you abuse it. Temazepam is a benzo, too, btw.

There are a lot of options still left to try.

I wondered about Wellbutrin, but I've heard that it can cause anxiety so I wasn't sure about trying it.

I'm guessing she's referring to benzos. She said the Xanax is just meant until we find something else that works long-time. She only gives me a 10 day supply at a time ... though I have never taken it the full 3 times per day.

[tryp]

Basically, you have a lot of medications still available to you - so many that it's really difficult for us to advise you one way or another. Unfortunately, the best thing to do is just keep trying until you find something that works.

Unfortunately in most cases you will have to have some tolerance to either sedation or activation. It's a rare med that won't at least give you a twinge on one side or the other.

[Kodos]

The drowsiness of Remeron should wear off after a while - it hits the histamine H1 receptor, which is why it makes you sleepy.

Wellbutrin rocks. Worth considering.

Emsam.

[jt07]

I've been taking Remeron for over a year, and I can attest to the fact that the daytime sedation goes away after a while. Now I could even take it during the day if I needed to and still be functional. I take mine at 10:00pm and I'm still up at 2:00am. So, yeah, it will get better.

Incidentally, Remeron is a tetracyclic antidepressant and not a TCA (tricyclic antidepressant). This is a big difference for me because I don't tolerate TCAs at all which leave me feeling spacey and drugged. Remeron doesn't do that to me.

[melissaw72]

Wellbutrin rocks. Worth considering.

Emsam.

Ditto.