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607502 tn?1288247540

Getting off Remeron

Hi Everyone

I am taking Avanza (Mirtazapine) which is sold in the US as Remeron.

I am going to move off this one way or another as Its not working as an AD, I have experienced rapid weight gain, have swollen ankles and now gout and my anger is getting worse and worse (a side effect not noted by the manufacturers but one other BP's say they have experienced on the drug)

According to what I have read you can move off this to another drug within 24 hours safely but as there are known risks to BP's from withdrawl of AD I was wondering if anyone here has any experience with the drug and moving off it and if possible what you moved to.

I am trying to move to Wellbutrin which is sold here as Zyban but its only approved on the Prescription Benefit Scheme as a smoking cessation drug here (Thank you Glaxo Smith Kline for going after the money and not patient care) so that might be hard.

Any advice would be great.
11 Responses
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585414 tn?1288941302
Yes as I said I have used Remeron. It was a nightmare. It was off label for control of tardive dyskinesia but being that I have the bipolar aspect of schizoaffective and am helped by mood stabilizers the same as everyone here and was made psychotic by Anafranil (for misdiagnosed ocd) which is an anti-depressent in this case I wouldn't say my reaction was atypical. I slept all day and was binge eating and became wildly manic from it. I was on it for a few days and I asked my psychopharmocologist if I could stop it immedietely and he said it would not be a problem. Then again I don't know if I had been on it long term if he would have accepted this. I may have many atypical reactions to medications but I have done well on the same mood stabilizers as most people here and avoided anti-depressents for the same reasons and I know Remeron was a hellish experience. I'm sure many people with depression find it tolerable.
  I'm of the knowledge that any serotonin boosting medication or natural remedy (including the rhodiola I take which I've lowered now that I started the Tenex) will likely cause mania. It is a difficult issue when a person needs an adjunct anti-depressent who has bipolar. I haven't had this experience so I can only suggest Wellbutrin from my knowledge but I can say my reaction to Rozerem for a person with bipolar (or the bipolar aspect of schizoaffective in my case) was not atypical. As for how fast you can go off it that I would ask your psychiatrist for a specific titration schedule to be on the safe side.
Helpful - 0
607502 tn?1288247540
I am going to discuss Lamictal with my Pdoc when I see him on Jan 20th, its just not something a family doctor is willing to prescribe, well not a good one anyway, realistically if i want Lamictal or Zyban (Wellbutrin) I just need to find a big 24hr medical center where patients are cattle and ask the doctor for them but im not convinced thats the right way.

What I read on Endep indicates it might be better for me than Mirtazapine in side effect profile and treatment, it seems to be something people have used with success.  it does have a warning for Lithium but everything has a warning for lithium so whats new there.

Still tossing it up, I have not filled the script yet but I have to do something; I have 3 Mirtazapine left so I have to fill one script or the other or stop taking the AD.

The drug information for Mirtazapine says its easy to move off as you can just stop it.  However other people say its not that easy at all with insommnia being a major problem, then again Ive only taken it a few months so its not long term.

The doc wants me to have at least 24 hours between drugs.  I dont know.

Surely someone else here has used Remeron?
Helpful - 0
Avatar universal
I can't imagine not having guaranteed health care, I agree something is wrong with the US system, as well, the drug costs are prohibitive. Although we have universal health care in Canada, our med costs are close to that of the US, and that's simply because we've allowed the drug companies to get away with it, many countries won't allow such pricing. Though I know some drug companies are giving drugs to people who can't afford them otherwise, sadly there are regulations here that won't allow it. My Nexxium WITH my private drug coverage is 100/mo - and "fair" pharamacare won't approve the drug as part of it's drug group. It only has one drug approved for my illness, and it doesnt' work for me. Nice eh? Lamactil is covered partly by my private insurance as well, not by pharmacare OR Plan G.  I always have to check if a drug is approved before I can go on it. In the last year I have spent close to 5k in out of pocket expenses for these drugs.

sorry probably babbling. Monkey I would hold off going off your meds until after xmas, just in case you end up in bad shape unless you are just simply switching over to another one, I don't want to see our favourite monkey rough around the tail!!
Helpful - 0
585414 tn?1288941302
Actually I was originally on Lithium and Lamictal was added. It was only when my psychopharmocologist saw that the Lamictal was working so well (remember it had just started usage as a mood stabilizer, this was 1998) that he gradually took me off the Lithium. I can say for standard psychiatric usage they are safe in combination with no particular interactions. I just felt a bit slogged.
  As per American healthcare coverage I have Medicare which includes Medicare Part D and Medicaid to supplement it. To get the Medicaid I have to put in some on the books telecommuting through a program called the Medicaid Buy In for Working People with Disabilities. Both of them together cover everything except medications that are not FDA approved (which includes a certain amount of what I am taking but if that's documented I may try to appeal that as well). Its fair minded. The only problem is most Americans without qualifying disabilities don't have these programs but in the coming administration that could change. But that's a side note to a much more serious issue you are facing.
Helpful - 0
607502 tn?1288247540
no GP is willing to add a mood stabiliser, they just wont take the risk in this day and age - I asked a out Lamactil but he just isnt wiling, cant say I blame him to be honest.

Im pondering just stopping the AD entirely, m not sure its done anything for me at this point and getting off Remeron seems pretty easy.

Not sure yet, some reading to do, I dont know Endep as its not one I have seen before or heard of anyone using, I know some of the Tricyclics can be very bad news.

Realistically the Australian PBS mode pretty much covers the majority of stuff, its just experimental or unusual drugs which fall outside and sometime into the grey area, people like to complain about it but they miss the fact that we get super cheap scripts as a right not just dependant on your insurance - for example my Lithium Carbonate scripts cost me $12-15 for 200 250mg tablets depending on where I fill it and there is a cap which then reduces that again after a dollar spend (cant recall how much) - an online search from a US discount web pharmacy shows me a price for 200x150mg at $79.25 which is truly terrifying.

When you hit things like Wellbutrin it just means an extra hoop and cost in some cases.

I again am glad I do not live in the USA when i look at this stuff.  Ho in gods name have you all stood by and let your government do this to your health care system?  
Helpful - 0
585414 tn?1288941302
So in Canada they don't have a system of appeals? That's disappointing. I think the American healthcare system is lousy but for people who are Medicare or Medicaid eligible (unfortunately not many people fall in that category) having a medication that's not on the formulary denied has multiple levels of appeals. I'm not putting this in as a side discussion I'm just asking if there is no chance you could appeal the denial of coverage yourself. I know Medicare Part D in the United States was set out to deny people coverage and I knew to appeal it at every step and I got the coverage I needed for Zofran which would have been $500 otherwise and its usage in tardive dyskinesia and as an adjunct for schizophrenia is experimental. Lamictal has been an approved mood stabilizer by the FDA for over half a decade and marketed throughout the world in this regard. If they only approved mood stabilizers that were originally marketed as such that would limit them to Lithium so is that the case there?
Helpful - 0
Avatar universal
Wellbutrin, and I can only speak from experience, set me right off, I was a ball of rage and anxiety. Though my pdoc has mentioned it if my depression dropped again, they might put me back on it. I'm scared are heck, I don't like being cranky!

These drugs are so expensive. I've had to file for what we call Plan G here, but it doesn't cover Lamactil as it's an anti-seizure drug. My meds costs have gone down from 200/mo to 120/mo so I'm not going to complain but geez, I can't live w/out these meds.  Last month I had a choice of eating or getting meds before my plan G went into effect. I had to gulp my pride and call my parents, and I'm 40. It's frustrating that we may be limited in our treatment due to cost, I just don't think it's fair.
Helpful - 0
585414 tn?1288941302
I know you know more than me about anti-depressents but I honestly don't know of any anti-depressent that won't worsen bipolar except Wellbutrin. I'm sure you've looked it up before but comb through that "Depression Central" website. It has information and also good links as I've said since it is run by a mood disorders specialist (albeit one I'm not associated with) so I know the information on there is clinically accurate. You could also post the question in the expert forum as well. Its difficult because Wellbutrin aside I've known so many people with bipolar who had their mania worsen with an anti-depressent.
   Well that would be a month until you could change to Wellbutrin. That would be a change over from Remeron to Endap and then another change over to Wellbutrin. That many prescription changes is bound to do havoc to you mentally I would think as it takes your brain a while to accustom itself to one medication as another gets out of your system.
  What mood stabilizer did you say you were on? Not that it should be changed but I wonder if Lamictal could be added as it does have an anti-depressent effect and if you are considering changing it like you said you might as well start now since it will take months to build up to a proper dosage. With Lamictal added you might feel swamped with medications as I did adjusting from Lithium to Lamictal but at least it would not worsen mania and could potentially help on the depression. I believe you are on Depakoate and when I was on that it worked well on mania but did little for depression. I believe its more effective on mania overall so maybe that's the problem. Again that site would be good to confirm it as a lot out there is inaccurate.
Helpful - 0
607502 tn?1288247540
Apparently my pdoc can prescribe it for me but he's away until late jan.

With the PBS it's not a matter of denial of the drug but cost - with off label the safety net may not apply - safety net drugs are capped at a Max of 33.20 per script but drugs not under PBS they can be expensive.

GP's here have prescribing guidelines so I need to see my pdoc. If it was not Xmas I
May have taken an SSRI but not this time of year...

I'm just not sure whether it makes we sense to change now or not.

I'm out and about and reading is hard on the iPhone but I know some tricyclics are bad for bp'd
Helpful - 0
585414 tn?1288941302
Think about one aspect considering that Wellbutrin is the least likely out of all the anti-depressents to potentially worsen the manic aspect of bipolar. If this were the United States I'd know exactly how to advise you but I know that in the United States any denial of coverage can be appealed. I was denied for the Zofran on a couple of levels until I recieved coverage. However, there is one resource that is the same in Australia.
Thankfully they have independent living centers and they can assist you as here with
appeals as regarding prescription coverage:
http://www.ilcaustralia.org/home/default.asp
If its not on the formulary of any standard drug plan it can be appealed on the grounds
that it would be the one least likely to potentially worsen mania. I also know in the United States a doctor can prescribe any medication (as long as its not a controlled substance) for any use. Zofran is technically officially approved only for nausea from chemotherapy for example. And if I had gone on Tetrabenzene they would have had to import it from Canada. If you are satisfied with the other medication fine. But don't let the bureaucracy of the health care system get in your way.
Helpful - 0
607502 tn?1288247540
The GP has prescribed Endep which is a Tricyclic AD. Not his first choice but as I cannot take an MAOI and won't risk an seri over Xmas with no supervision he does not have much choice.

Asked about wellbutrin and gp's can only prescribe for smoking cessation here - should have just said I wanted to quit maybe but the govt limits how much you can get in a year which makes it hard.

So Endep. Anyone used it?
Helpful - 0
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