Anxiety? Remeron related?

[[cz...]]

I am three weeks out from my last Ativan. I c/t'd without knowing I probably should have slowed down. Anyway, it seems that i get a manic, anxious feeling roughly the same time every day (mid-afternoon...no real triggers per se), so I'm wondering if it is related to withdrawal or to my use of Remeron. I started Remeron two weeks ago, and the anxiety "attack" type feeling started the day after I started on it. However, this was also the 4th day after I quit Ativan, so I'm not sure what to blame for it. I take the Remeron at night before I go to bed (around 10:00 usually). Seems fishy.

 

 

[[ve...]]

Hi CZ.  That's the thing about adding other medications during acute withdrawal.  You never really know for sure which is withdrawal and which is side effects from medication.  That being said, I would guess it's more withdrawal, given it's only about two to three weeks since your c/t. You can probably expect side effects from the c/t to peak in the first month before starting to settle back down.  The remeron might help with the anxiety as I've read that sometimes it takes a few weeks to build up in the system, at least that seems to be the case with SSRIs.  Prozac, for example, I believe is known to potentially cause increased anxiety and even suicidal ideation in the first weeks to a month of taking it before it supposedly starts to have a more "positive" effect.  I was glad, by the way, to read on another thread where you posted that you were starting to feel a little better.

 

Vertigo

[[cz...]]

Thanks. I am feeling better "overall." But the prolonged "anxious" times are very disconcerting. I agree that adding other variables muddies the waters.

 

Veritgo, I know you are very knowledgeable about all this stuff. Do you think Remeron will actually hinder my healing, or in some way protract it? I'm still on the fence about coming off all these brain drugs. I am DEFINITELY coming off Zyprexa. Seeing my psychiatrist today. I do not want to stay on that thing any longer. Hopefully, it will be easy to do after only one week. I am also going to request slowly tapering down my Remeron, perhaps getting down to a lower dose. I am pretty convinced the anxiety stems from it, but who knows. My overall plan, hopefully, is to 1) get a little more stable sleep/anxiety wise 2) get back to teaching to have a sense of normalcy 3) wean off all drugs heading into summer break (insomnia, etc. won't matter if I don't have any real obligations)....Hope I can follow this plan. I want my life back!!

 

[[we...]]

I had inter-dose withdrawal from Remeron, I'm sure.

[[pa...]]

Cz,

 

This is a hard question to answer.  Some buddies, who have been on benzos a lot longer and have habituated to them (with brain adaptations causing a decrease in GABA ) may actually get off benzos and do well on Remeron as an adjunctive therapy for recovery.  I am one of them. I've done better and better in recovery with my use of Remeron. And over time, as GABA has healed, I've required less and less of it.  From 15mg at jump to 3mg now. 

 

However, there are several cases of folks I've read about on here who actually started benzos in response to a panic that came on after starting Remeron.

 

I think that this is the same outcome as in other meds - some folks do great on a med, while others don't.

I also think this is dose-dependent and body-specific. Remeron works to directly increase serotonin and at doses higher than 15mg, it acts to increase norepinephrine as well (noradrenaline, which is like getting a shot of adrenaline).  But this 15mg "level" is not an exact science.  It stands to reason you coudl get a norepinephrine effect from a lesser dose.  I get a great serotonin effect from only 3mg, where there are people on the depression boards who are on upwards of 60mg of Remeron and label it as "too weak to affect my depression" - and they aren't even on benzos.  So- there are simply too many factors to know, which is why psychiatry is so much trial-and-error.

 

I don't think it's possible for us to know how you're reacting for these reasons, but you may have a gut intuition about it.  When I have feel I am ready and able to cut down the Remeron, I simply do it slowly and wisely- remembering that I may not feel the effect of cutting it down right away. Physically it may be harder to sleep one night, but the actual neurotransmitter effect may take a week or more. So anything I've done with Remeron, I've learned to do it slowly. 

 

I know this isn't a clear answer. I don't think I have one. Just that you can probably figure this out intuintively, and take the time to do things slowly so not as to upset your system.

 

:)Parker

[[cz...]]

I was started immediately at 30 mg Remeron. Been on it for about three weeks. My gut instinct is that it is causing the anxiety I am feeling. No way to prove it. Doc says that is not really possible (I hate doctors now). I am afraid it is complicating things for me. I'm not even really convinced that I am having Ativan withdrawal.

 

Parker, since you've had experience with Remeron, do you think I should ask the doc to take down my dose and see how I react. Since I've only been on it for three weeks, could I jump down to that level quickly?  I will ask the doctor, but it's tough to trust them implicitly b/c they are so married to their pill prescriptions. Thanks.

[[pa...]]

Cz,

 

Certainly you can ask your doctor this. OR, you can just tell him you want to come down off of it, and ask how. It is not his choice. It is yours.  Definiely work with him on it, because even if you do come down, you'll need him to prescribe it while you're doing whatever you decide. 

 

I feel the same about pdocs now.  I got this Remeorn from my GP as help after the benzo jump was impossible for me. My GP is very cool about believing me and allowing me to use Remeron in the way I feel best.  He admits these drugs affect everyone differntly. He is he only doctor I trust, but even then, after this, I will never take  a psych drug again.

 

Work with your doctor.  Ask him if it's safe to do what you want to do - and how fast can you do it - and then do what you both decide is best.

 

:)Parker

[[cz...]]

Thanks for the reply. I am just so stuck here. If, in fact, I am in Ativan withdrawal, then the Remeron may actually be helping me. However, I find it too coincidental that my anxiety attacks began after starting it. They also coincide with coming off the Ativan. It is so confusing right now. My poor brain is addled with all this. I do not find it helping me much depression-wise, but of course the doctore wants me to stay on it longer. I am torn on what to do. The blind taking of drugs got me into this mess, so I'm not sure how the blind taking of more drugs will help. I desperately want to get back to work, and the way I feel daily right now, that is not a possibility.

 

Overall, however, is using Remeron hindering my Ativan withdrawal? Is it protracting my recovery? Any ideas on this?

[[pa...]]

I do not think it is hindering recovery of your receptors, however, it may be revving you.  If I felt the way you describe, I'd ask him about going down to 15 and see if that has a beneficial effect (that he intends) without making you feel shaky, panicky, etc.

15mg of Remeron made me almost high as a kite happy. No kidding. (Not in the beginning after my jump but when I restarted it in month 3 post jump, I had a complete lift of anxiety and depression in 5 days at 15mg). I never tried more than that, so I can't comment on how it might affect anyone. What I have stated about norepinephrine is in relation to what I have read about how the drug works, how others describe their experience, and how others on message boards for depression state their experiences.

 

Some on other boards say that it is "too sedating" at doses of 15mg or less, but that you can counter that by taking higher doses than 15mg - and then when norepinephrine kicks in, it's not as sedating.  Remeron also acts on histiamine reptors (like benadryl does) and so this is why it is so sedating. But it may be at doses higher than 15, the norepinephrine actually overcomes the sedation affect. Because this med acts on different receptors in different ways, you can see how the dose alone may make this seem like "a different medicine". 

 

I know that Pangelingua healed from benzos and he is still on 3-7mg of Remeron.  BUT he stated that the higher doses were too revving for him.  You may try and write him for his personal experience.  Other than that, perhaps discuss changing the dose with your doctor.  If you do better at a lower dose you'll know shortly.

 

:)Parker

[[Bi...]]

Hey there,

 

I was on Remeron about 6 months back in 2006. In Jan. of 2007, I decided to go off the Remeron, so I cold turkey it. I was on 3mg of Klonopin at that time. So, that may have held the withdrawal from Remeron back. I was on 15mg of it a night. I honestly didn't have any withdrawal from Remeron, but that is not speaking for everyone. The only thing Remeron did for me was make me eat, but I ate healthy on it. In fact, I was told by a doctor.. Remeron can be prescribed to anorexics, in which that is not why it was prescribed to me! It was prescribed for sleep because Klonopin did not do anything for my sleep. I ate loads and tons of food on this pill lol.. just come off it safely if you need to.

 

@ Parker, I don't think Remeron is a cure for withdrawal.

 

Cz,

 

This is a hard question to answer.  Some buddies, who have been on benzos a lot longer and have habituated to them (with brain adaptations causing a decrease in GABA ) may actually get off benzos and do well on Remeron as an adjunctive therapy for recovery.  I am one of them. I've done better and better in recovery with my use of Remeron. And over time, as GABA has healed, I've required less and less of it.  From 15mg at jump to 3mg now. 

 

However, there are several cases of folks I've read about on here who actually started benzos in response to a panic that came on after starting Remeron.

 

I think that this is the same outcome as in other meds - some folks do great on a med, while others don't.

I also think this is dose-dependent and body-specific. Remeron works to directly increase serotonin and at doses higher than 15mg, it acts to increase norepinephrine as well (noradrenaline, which is like getting a shot of adrenaline).  But this 15mg "level" is not an exact science.  It stands to reason you coudl get a norepinephrine effect from a lesser dose.  I get a great serotonin effect from only 3mg, where there are people on the depression boards who are on upwards of 60mg of Remeron and label it as "too weak to affect my depression" - and they aren't even on benzos.  So- there are simply too many factors to know, which is why psychiatry is so much trial-and-error.

 

I don't think it's possible for us to know how you're reacting for these reasons, but you may have a gut intuition about it.  When I have feel I am ready and able to cut down the Remeron, I simply do it slowly and wisely- remembering that I may not feel the effect of cutting it down right away. Physically it may be harder to sleep one night, but the actual neurotransmitter effect may take a week or more. So anything I've done with Remeron, I've learned to do it slowly. 

 

I know this isn't a clear answer. I don't think I have one. Just that you can probably figure this out intuintively, and take the time to do things slowly so not as to upset your system.

 

:)Parker

 

I'm not too sure about the highlighted above either, and would have to look it up.. if it's actually on the net.

 

Anyway- Good luck CZ

 

Billy.

 

Edit:  Typos

[[pr...]]

cz, I won't repeat what everyone else has  said, you've gotten some great feedback on this thread.

 

Just want to add:  now, so soon after a benzo CT, is NOT the time to be trying to get off other meds! At least not the ones you've been on for a long time; I can't say about the Remeron, other than to taper it.  Personally I wouldn't change ANYthing.  In immediate acute benzo w/d it's my experience that changing meds in any way almost always makes things worse and I've never seen it make anything better.

 

You need time to heal from that CT and if it were me I would change NOTHING for at least six months.  Then you can do a reasonable taper off any  meds you want to taper off.

 

Your healing from this CT is only beginning and right now you have no idea what the next few months are going to bring--it could be easy, it could be hard, you don't know yet.  Don't set yourself up for great suffering!

[[pa...]]

Billy  - I also do not think Remeron is a cure for withdrawal. The only cure for withdrawal is time.  No amount of Remeron will make GABA re-upregulate. 

 

However, for me, and for others, Remeron allows some to be functional, to sleep and to eat- which are helpful to healing.  Certainly, for me, this was a better choice than reinstating.

 

Billy - here is a professional journal article mentioning the use of Remeron for this purpose. It gives a scientific rationale:

http://smj.sma.org.sg/4906/4906cr8.pdf

 

Beyond that, you can read about Remeron on wikipedia and see clearly that it acts on histamine, serotonin, and noradrenergic receptors.

The REST of what I have stated about norepinephrine, I stated clearly that I have read through anecdotal inferences made on message boards by those who have taken or are taking Remeron, as well as a thread I read from pdocs themselves discussing the way they use Remeron with their patients.  I do not have these bookmarked, but again, I am not a doctor, and I have stated that what I have read has led to my inferring that this medicine acts on norepinephrine at higher doses. If this is the case, as I surmise it is, then it stands to reason how one may feel increased anxiety with the increase in norepinephrine. http://en.wikipedia.org/wiki/Norepinephrine

You can read about how norepinephrine works, here. I think you will find my description accurate.

 

I would certainly NEVER steer another buddy wrong. What I have stated is neutral - Remeron helps some, but not all people. For me, and for several others, it has been a great coping tool through benzo withdrawal and recovery. However, if you will look back to my post to CZ, I clearly share that this is her choice - and that she should work with her doctor.  Everything I know about this drug has been through reading or word-of-mouth - or my doctor. But truly, even that is hard-pressed to be 100% accurate, as these are drugs -and just like benzos do not affect everyone the same, no drug does.

 

The choice has to be Cz's. I was simply trying to give her some rationale as to why Remeron may indeed be revving her at the higher doses - so that she doesn't feel abnormal.  I am trying to help another buddy with some information she may use as food for thought and in discussion with her physician.

 

:)Parker

[[cz...]]

cz, I won't repeat what everyone else has  said, you've gotten some great feedback on this thread.

 

Just want to add:  now, so soon after a benzo CT, is NOT the time to be trying to get off other meds! At least not the ones you've been on for a long time; I can't say about the Remeron, other than to taper it.  Personally I wouldn't change ANYthing.  In immediate acute benzo w/d it's my experience that changing meds in any way almost always makes things worse and I've never seen it make anything better.

 

You need time to heal from that CT and if it were me I would change NOTHING for at least six months.  Then you can do a reasonable taper off any  meds you want to taper off.

 

Your healing from this CT is only beginning and right now you have no idea what the next few months are going to bring--it could be easy, it could be hard, you don't know yet.  Don't set yourself up for great suffering!

 

I have not been on Remeron long. In fact. I stopped Ativan Wednesday 3/14, and started Remeron Sunday 3/18. That is the crux of my issue. I'm not sure if I'm even really having Ativan withdrawal or not. I started having anxiety attacks after beginning the Remeron. It just happens to coincide with stopping Ativan. Really confusing time for my brain and me. Lots of drugs affecting my brain. I'm tempted to taper down the Remeron and see what lies beneath, but I was dealing with depression for this past month, so I am reticent to do that.

 

On another note, does Benadryl or similar products slow down recovery from benzo use? If, in fact, Remeron works the same way, then I am actually not helping myself in that regard at all.

[[ve...]]

I personally would take as low a dose as possible, if it were me.  I agree that tapering completely off at this point in the c/t does not sound like a prudent decision, unless you and/or your doctor feel the remeron is having a negative outcome.  In my mind, I would try to go down to 15-20mg remeron and see if it's enough to take the edge off, help you sleep without making you too groggy or spaced  out. Eventually maybe you can go to 7.5 in a few months?  Check with your doc!

 

Best,

 

Vertigo

[[pa...]]

Vertigo - I agree. That is exactly what I would do, too - try to talk the doctor into going down to 15 to see if it can stop from potentially revving you. I just wasn't sure if I could say that directly. 

 

That is exactly what I have done throughout this process, too.  I was thankful to have had this med to carry me through the non-sleeping months, but over time, I cut it down myself.  The less I'm on in recovery, the more my brain must do for itself.  But I had to be patient in the beginning, because my brain just didn't know how to sleep.  Ironically - the Remeron just made me sleep - and over time, that is how I've healed. 

 

Everyone is different, Cz.  The great take-away here is that you probably CAN tell him you just want to try less. That sounds reasonable. It's not as if you cannot go back up! 

 

:)Parker

[[pa...]]

Cz - Sorry! I guess you're not a "her". You're a "he". 

[[Bi...]]

Billy  - I also do not think Remeron is a cure for withdrawal. The only cure for withdrawal is time.  No amount of Remeron will make GABA re-upregulate. 

 

However, for me, and for others, Remeron allows some to be functional, to sleep and to eat- which are helpful to healing.  Certainly, for me, this was a better choice than reinstating.

 

Billy - here is a professional journal article mentioning the use of Remeron for this purpose. It gives a scientific rationale:

http://smj.sma.org.sg/4906/4906cr8.pdf

 

Beyond that, you can read about Remeron on wikipedia and see clearly that it acts on histamine, serotonin, and noradrenergic receptors.

The REST of what I have stated about norepinephrine, I stated clearly that I have read through anecdotal inferences made on message boards by those who have taken or are taking Remeron, as well as a thread I read from pdocs themselves discussing the way they use Remeron with their patients.  I do not have these bookmarked, but again, I am not a doctor, and I have stated that what I have readed has led to my inferring that this medicine acts on norepinephrine at higher doses. If this is the case, as I surmise it is, then it stands to reason how one may feel increased anxiety with the increase in norepinephrine. http://en.wikipedia.org/wiki/Norepinephrine

You can read about how norepinephrine works, here. I think you will find my description accurate.

 

I would certainly NEVER steer another buddy wrong. What I have stated is neutral - Remeron helps some, but not all people. For me, and for several others, it has been a great coping tool through benzo withdrawal and recovery. However, if you will look back to my post to CZ, I clearly share that this is her choice - and that she should work with her doctor.  Everything I know about this drug has been through reading or word-of-mouth - or my doctor. But truly, even that is hard-pressed to be 100% accurate, as these are drugs -and just like benzos do not affect everyone the same, no drug does.

 

The choice has to be Cz's. I was simply trying to give her some rationale as to why Remeron may indeed be revving her at the higher doses - so that she doesn't feel abnormal.  I am trying to help another buddy with some information she may use as food for thought and in discussion with her physician.

 

:)Parker

 

Thanks Parker.

 

I answered your question at anxiety zone BTW. about Clonazepam.

 

Billy.

[[cz...]]

Cz - Sorry! I guess you're not a "her". You're a "he". 

 

No problem! Thanks for the info; I will be more knowledgeable at my appointment tonight. I hope going down in mg. won't be a problem after being on 3 weeks. I certainly don't want to deal with some kind of Remeron rebound anxiety. My concern is that it might be too sedating at lower doses. Ironically, even though I am more "revved" up anxiety-wise, I otherwise feel a bit dull-headed and zombified from the neck up. Stupid chemicals...pharmaceuticals got me into this mess.

[[pa...]]

I hear you,Cz. Once I'm done with this experience, I will put only food in my mouth. 

[[cz...]]

Sadly, I did not heed the advice of a friend of mine who is more into natural remedies. Direct quote from him "watch out with sleeping pills and stuff like that; you are asking for a whole other set of problems." Boy, was he ever correct. I am a total moron for not trying something more natural to try to sleep early in this experience. Parker, I agree. After this total fiasco, I will NOT be relying on pharmaceuticals for anything at all if I can help it.

[[ve...]]

Sadly, I did not heed the advice of a friend of mine who is more into natural remedies. Direct quote from him "watch out with sleeping pills and stuff like that; you are asking for a whole other set of problems." Boy, was he ever correct. I am a total moron for not trying something more natural to try to sleep early in this experience. Parker, I agree. After this total fiasco, I will NOT be relying on pharmaceuticals for anything at all if I can help it.

 

It can be a slippery slope, CZ as many of us found out about benzodiazapenes.  In some cases, a limited dose or limited a/d can be helpful to cope with sleep or other issues during the first few months to a year off the benzo.  Ultimately, if one can do it medication free, that would be great but not always possible.  I came close on a couple of occasions but managed to stay medication free.  Now at two years out, I have been experimenting with melatonin and small amounts of L-Tryptophan (amino acids) to see if I can get up to 8 hours of sleep.  I agree with Parker and have read elsewhere that getting proper amounts of sleep can be very important in the healing process.  I have managed to sleep between 5-6.5 hours a night and this has had to be enough. Yet I still believe that if I could get to 8 hours, I might be able to close the chapter on my benzo journey and change the 95% in my signature to 100%!

 

Vertigo

[[cz...]]

I hope you get that extra 5% soon, Vertigo!! You have been, and continue to be, a great help to me and many others here. Thanks!

[[ve...]]

I hope you get that extra 5% soon, Vertigo!! You have been, and continue to be, a great help to me and many others here. Thanks!

 

Thanks CZ.  Hope you have a good holiday weekend (if you celebrate either of the holidays tomorrow). Some people find Spring time in general can be a time of renewal (of the spirit at least) and hopefully will also be the beginning of a return to physical health and well being .

 

Best,

 

Vertigo

[[we...]]

At one time it was hypothesized that depression was due to low levels of serotonin in the brain and that antidepressants increased this level  But this theory was discredited by Ashcroft who showed that depression is not associated with or caused by a lowering of serotonin.[3]

 

^ Ashcroft, "The Receptor Enters Psychiatry," 189-200

[[cz...]]

Interesting. Of course, all I hear is "chemical imbalance"  over and over again. Stupid pharmaceuticals.