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1 hour ago, mike218 said:

Depressed mood, anxiety, irritability, loss of happiness, loss of interest and decreased self confidence. I have taken a MAOI I don’t remember the name it was a couple years ago. I get a allergic reaction to Wellbutrin so that’s out. I’ve taken many snri’s , but never with Remeron. I can’t take any adhd meds because I get drug tested at work. Yes the only one I can remember is aripipazole. 

If you provide a document from your prescribing doctor, they can't hold stimulants against you for work drug tests. It proves you have a valid medical reason for taking them.

1 hour ago, mike218 said:

I think I might try viibryd, mitzazapine or rameron. Do these have sexual side effects? I’ve also tried California rocket fuel???

Viibryd might have a little sexual side effects but not as much as typical SSRIs. Remeron is actually added to counter sexual side effects of SSRIs, so it can either do that, or even enhance sexual performance (anecdotally). The synergism between Viibryd and Remeron (mirtazapine, same thing) isn't exactly as much as you'd get with an SNRI + Remeron. You'd definitely get the serotonin bit, but the norepinephrine bit you wouldn't get.

Based on your response, you have a potential dysfunction in serotonin, norepinephrine, and possibly dopamine neurotransmission. SNRIs can benefit this because norepinephrine reuptake inhibition indirectly increases dopamine in the frontal cortex. TCAs also do this as they're non-selective "dirty" SNRIs. The secondary amine TCAs, desipramine, nortriptyline, and protriptyline, work more on norepinephrine and generally have a cleaner side effect profile than the tertiary amines, which work more on serotonin but produce a tertiary amine as an active metabolite that works on norepinephrine. The typical "California Rocket Fuel" recipe is Effexor XR + Remeron (at a higher dose, 30-45 mg, where it acts more as an antidepressant and less as an appetite stimulant and sedative), but any SNRI + Remeron will do. Pristiq + Remeron would be close to Effexor XR as it is the synthetic active metabolite of Effexor, but Cymbalta would be more potent IMO. Fetzima I never had good luck with so I don't really advocate for that medicine.

Another thing to do is more or less "create" an "SNRI" by taking an SSRI and a secondary amine TCA, my favorite (what I'm on now) being Zoloft + desipramine. Protriptyline is pretty good too, but it's kinda anticholinergic and can cause blurry vision, urinary retention, constipation, etc. But they don't cause sexual side effects as much as the SSRIs/SNRIs. Then combining Remeron with that could even further synergize the combination, granted you'd be on three antidepressants concomitantly.

But if Viibryd and Remeron is what you want to try, I'd recommend doing just Viibryd first before adding the Remeron so you can tell what's doing what.

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Holy crap lol that’s a lot of input. California rocket fuel = venlaflaxtine and mirtazapine. I’ll look at the rest when I can concentrate. I have a commercial driver license and any thing that’s a stimulant would make my license revoked. 

I’m going to give lamictal and gabapentin a little longer to see what happens. I see the dr in 3 weeks and get her opinion. Thanks for all the information!!

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4 minutes ago, mike218 said:

I have a commercial driver license and any thing that’s a stimulant would make my license revoked. 

That's asinine... 😕 

4 minutes ago, mike218 said:

I’m going to give lamictal and gabapentin a little longer to see what happens. I see the dr in 3 weeks and get her opinion. Thanks for all the information!!

You're more than welcome!

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12 hours ago, mike218 said:

My problem is I’m sad/mad and idk what what will help?

[Lamictal] PERFECT for a combination of sad and mad, even if no bipolar.

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1 hour ago, mikl_pls said:

 

Based on your response, you have a potential dysfunction in serotonin, norepinephrine, and possibly dopamine neurotransmission. SNRIs can benefit this because norepinephrine reuptake inhibition indirectly increases dopamine in the frontal cortex. TCAs also do this as they're non-selective "dirty" SNRIs. The secondary amine TCAs, desipramine, nortriptyline, and protriptyline, work more on norepinephrine and generally have a cleaner side effect profile than the tertiary amines, which work more on serotonin but produce a tertiary amine as an active metabolite that works on norepinephrine. The typical "California Rocket Fuel" recipe is Effexor XR + Remeron (at a higher dose, 30-45 mg, where it acts more as an antidepressant and less as an appetite stimulant and sedative), but any SNRI + Remeron will do. Pristiq + Remeron would be close to Effexor XR as it is the synthetic active metabolite of Effexor, but Cymbalta would be more potent IMO. Fetzima I never had good luck with so I don't really advocate for that medicine.

 

My pdoc says "even 45 is too much" of Remeron. From personal experience his assumption was correct for me as going from 30-45 was no benefit + more side effects. The best relief from Remeron was going from 15 to 30. 7.5 just makes me feel like shit and eat everything in the house. I'm ALL for starting at the lowest dose but you probably want to skip 7.5 and try 15 for a week or two then up to 30. 7.5 just makes the depression worse for me.

Edited by Sephiroth999

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4 hours ago, Sephiroth999 said:

My pdoc says "even 45 is too much" of Remeron. From personal experience his assumption was correct for me as going from 30-45 was no benefit + more side effects. The best relief from Remeron was going from 15 to 30. 7.5 just makes me feel like shit and eat everything in the house. I'm ALL for starting at the lowest dose but you probably want to skip 7.5 and try 15 for a week or two then up to 30. 7.5 just makes the depression worse for me.

I have been on both 30 mg and 45 mg, and 45 mg was hell. I felt like absolute shit. My depression worsened significantly and I couldn't stay awake. They say it becomes more stimulating in higher doses. That was not my experience. 30 mg didn't do anything for me except make me binge eat even well after I stopped taking it. Remeron has never helped me, but it is a miracle med for many people, especially in the higher doses. Some people go as high as 60-90 mg.

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45mg felt like a totally different drug to me. Way too much stimulation with 300mg of bupropion on-board. 30mg and below was a horse tranquilizer.

I also got a cavity due to dry mouth and extreme sugar cravings.

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200mg Lamictal was good for my depression. When I dropped Abilify I had to up Lamictal to 400mg to get the same effect. Great again.

I do still take it along with Wellbutrin 300mg and Prozac 20mg.

I'm with @mikl_pls about Remeron except that it didn't increase my appetite... it gave me depersonalization instead, which is really scary. I am generally open to (re)trying meds but I'm *never* touching this one again.

 

Edited by HydroCat

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