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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Elroy on June 3, 2005, at 16:55:03
Noted new report issued (last week?) on Remeron effectiveness:
http://www.docguide.com/news/content.nsf/news/8525697700573E188525700E00608A93
QUOTE:
Mirtazapine Betters Major SSRIs for Treatment of Depression
By Bruce SylvesterATLANTA, GA -- May 27, 2005 -- A meta-analysis of clinical trials involving more than 2,500 subjects suggests that treatment of depression with mirtazapine (Remeron) results in a more rapid onset of clinical improvement compared to treatment with fluoxetine, paroxetine, and sertraline (all SSRIs), researchers reported here May 24th at the 158th Annual Meeting of the American Psychiatric Association (APA).
"Mirtazapine is mechanistically a different kind of antidepressant than the more widely prescribed SSRIs or selective serotonin reuptake inhibitors," said presenter and lead investigator Michael Thase, MD, professor of psychiatry at the University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania, United States. "One of the consequences of a mechanistic difference is that it may follow a different temporal characteristic. … There is about a one week earlier onset of benefit with mirtazapine."
The investigators conducted a meta-analysis of data from 12 double-blind, randomized, controlled trials of mirtazapine versus SSRIs, involving more than 2,500 depressed patients. They compared remission rates (Hamilton Rating Scale for Depression -17 Item [HAMD-17] less than or equal to 7 or Montgomery-Asberg Depression Rating Scale [MADRS] less than or equal to 12) at weeks 1-6 and time-to-sustained remission using Kaplan-Meier graphing. They also calculated values of early response at week 6 as predictive of later remission.
After 6 weeks, remission rates were 38.8% for mirtazapine and 34.7% for SSRI-treated groups. "The difference between the two groups was statistically significant in favor of mirtazapine at all assessments and across time (P less than or equal to .03; Logrank test). This advantage was largely explained by the onset of remission during the first three weeks of treatment (P less than or equal to .001)," according to the authors.
They added that the results demonstrate that mirtazapine patients show a "significantly higher probability of response compared to SSRI-treated patients in the first three weeks of therapy" and that the sustained response indicated the same tendency.
The study was supported by Organon International, Inc., which manufactures Remeron.
END QUOTE
I did specifically note the last sentence....
What I find interesting is the language from another study:
http://content.karger.com/ProdukteDB/produkte.asp?Doi=68873
QUOTE:
Unlike other antidepressants, mirtazapine does not inhibit the reuptake of norepinephrine or serotonin but acts as an antagonist at presynaptic 2-receptors, at postsynaptic 5-HT2 and 5-HT3 receptors, and at histaminergic H1 receptors. Furthermore, mirtazapine has been shown to acutely inhibit cortisol secretion in healthy subjects.
END QUOTEHaving severe anxiety, I find that SSNRI products like Effexor and Cymbalta make my situation much worse. And have found that SSRI products like Lexapro simplydon't seem to work (not only had severeside effects with nausea and sexual dysfunction, but had "deadened" emotions while I could still readily detect that anxiety still there in the background).
Elroy
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Posted by Maximus on June 3, 2005, at 20:14:13
In reply to New Report on Mirtazapine, posted by Elroy on June 3, 2005, at 16:55:03
Thanks for the news. Hum, sponsored by Organon... Are you taking Remeron? If yes, are you able to tolerate it?
No emotion on SSRI/SNRI? Zombiefication is the hallmark of SSRI, see my recent post...
Posted by Elroy on June 3, 2005, at 21:06:31
In reply to Re: New Report on Mirtazapine » Elroy, posted by Maximus on June 3, 2005, at 20:14:13
No, will be starting it first part of next week (am on a wash out period right now). Am to do 15mg for 2-weeks and then go to 30mg for a while after that to see how it goes. My pdoc said that if I find the 15mg dose "too sedating" and "too much hunger pangs", to go up to the 30 mg dose earlier. Apparently the side effects are actually more intense at the lower dose. Actually since I have severe insomnia and almost no appetite, I might want to stay on the lower dose :)
Had the "deadened emotions" feeling with the SSRIs... plus with the SSRIs I could still detect the anxiety strongly in the background! Now with the SSNRIs, I had increased - very increased - levels of anxiety and extremely severe "prostatitis type symptoms" (i.e., burning urethra - not burning when I urinated, burning ALL the time). Was much, much worse with Effexor - and occurred almost immediately versus with after a couple weeks Cymbalta.
I find it interesting that in anxiety cases that most pdocs are so concerned with using an SSRI or SSNRI to treat them! Those meds are good in cases involving pure depression but have some - but limited - effectiveness at best with anxiety cases. If elevated cortisol is involved, often the SSRI or SSNRI choice can make the situation worse as some SSRIs and SSNRIs have been shown to INCREASE cortisol levels (which - of course- could be a good thing if LOW cortisol is the cause of your depression... but wil almost never be the cause of high anxiety).
Elroy
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> Thanks for the news. Hum, sponsored by Organon... Are you taking Remeron? If yes, are you able to tolerate it?
>
> No emotion on SSRI/SNRI? Zombiefication is the hallmark of SSRI, see my recent post...
>
>
Posted by ESB on June 6, 2005, at 13:55:07
In reply to Re: New Report on Mirtazapine » Maximus, posted by Elroy on June 3, 2005, at 21:06:31
Hi Elroy,
Interesting article. Thanks. Just curious, have you tried the benzodiazepines, such as klonopin, for your anxiety? They definetly have taken the edge off for me. SSRIs made me have the WORST panic attacks ever. Evil drugs for panic disorder IMHO.
Take Care,
ESB
Posted by Elroy on June 6, 2005, at 20:54:05
In reply to Re: New Report on Mirtazapine, posted by ESB on June 6, 2005, at 13:55:07
I use Xanax XR (1mg x 2 daily) for the anxiety - works about 75% efficiency rate about 90% of the time. Can always tell that there's something in the background keeping the anxiety "alive"... I believe it to be the highly elevated cortisol (which keeps "manufacturing" anxiety).
As Remeron has some very intersting studies showing its effects on lowering cortisol, well, I put together some info and provided it to my doc (actually my regular GP as next appt with pdoc wasn't for over a month)...
http://www.pslgroup.com/dg/2030E2.htm
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10451911&dopt=Abstract
http://www.docguide.com/news/content.nsf/news/8525697700573E1885256CFD004B4129
http://qualitycounts.com/fp/remeron.htmAnyway, my doc agrees with me and we're starting the Remeron this week. 15mg for 2 weeks and then upping it to 30 mgs.
Elroy
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> Hi Elroy,
>
> Interesting article. Thanks. Just curious, have you tried the benzodiazepines, such as klonopin, for your anxiety? They definetly have taken the edge off for me. SSRIs made me have the WORST panic attacks ever. Evil drugs for panic disorder IMHO.
>
> Take Care,
> ESB
This is the end of the thread.
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