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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Janelle on March 21, 2002, at 18:03:40
I have heard that one of these two meds is MORE sedating at LOWER doses and LESS sedating at HIGHER doses (in other words, an inverse relationship between sedation and dosage) but I can't remember for the life of me which one it is - Remeron or Serzone? I'm sure that someone here knows the answer to this and I'd greatly appreciate your posting it under here.
ALSO, what is the average therapeutic dose range for Remeron?
THANKS so much.
Posted by JohnX2 on March 21, 2002, at 18:17:05
In reply to REMERON vs. SERZONE questions:, posted by Janelle on March 21, 2002, at 18:03:40
Anecdotally, Remeron may be less sedating at higher doses. This is due to a higher norepinephrine boost at the higher doses.I believe Remeron's thereapuetic range is typically in the 15-45 mg range.
Regards,
John> I have heard that one of these two meds is MORE sedating at LOWER doses and LESS sedating at HIGHER doses (in other words, an inverse relationship between sedation and dosage) but I can't remember for the life of me which one it is - Remeron or Serzone? I'm sure that someone here knows the answer to this and I'd greatly appreciate your posting it under here.
>
> ALSO, what is the average therapeutic dose range for Remeron?
>
> THANKS so much.
Posted by Janelle on March 21, 2002, at 18:25:48
In reply to Re: REMERON vs. SERZONE questions: » Janelle, posted by JohnX2 on March 21, 2002, at 18:17:05
JohnX2 to the rescue as usual! (what's the X2 for by the way!) You always have the answers to my questions here! Thanks a bunch! I thought it was the Remeron that is LESS sedating at HIGHER doses, but needed to be 100% sure. Also, you provided an answer to an unasked (but important) question and that is WHY Remeron has this pattern - aboout the NE stimulation at the higher doses.
Posted by JohnX2 on March 21, 2002, at 18:59:32
In reply to Re: REMERON vs. SERZONE questions: » JohnX2, posted by Janelle on March 21, 2002, at 18:25:48
My codename was JohnX, but then Dr. Bob changed some registration policy and I had to reregister for some reason. The JohnX was already taken so I picked JohnX2.Remeron has a unique action at the norepinephrine receptors. It blocks a feedback receptor called the "alpha-2" norepinephrine receptor. This sits on the sending neuron and detects norepinephrine in the synapse. When it detects the norepinephrine it tells the sending neuron to slow down the release of norepinephrine (this keeps things in balance, otherwise we may shoot out of control). By blocking this receptor with medicine (Remeron), this causes the sending neuron to release more norepinephrine.
The way the pharmaceutical binds to the receptors and is metabolized by the body, etc, it just works out that the "alpha-2 blockade" is thought to kick in mostly at the higher dosing ranges (like 30-45 mg). At the lower doses, there is less norepinephrine kick. Remember that norepinephrine is generally stimulating.
Regards
John
> JohnX2 to the rescue as usual! (what's the X2 for by the way!) You always have the answers to my questions here! Thanks a bunch! I thought it was the Remeron that is LESS sedating at HIGHER doses, but needed to be 100% sure. Also, you provided an answer to an unasked (but important) question and that is WHY Remeron has this pattern - aboout the NE stimulation at the higher doses.
Posted by Janelle on March 21, 2002, at 23:49:56
In reply to Re: REMERON vs. SERZONE questions: » Janelle, posted by JohnX2 on March 21, 2002, at 18:59:32
Hi John,
Okay, I THINK (repeat think!) I follow what you said about Remeron's unique action at the norepinephrine receptors.
You wrote: "It [meaning Remeron] blocks a feedback receptor called the "alpha-2" norepinephrine receptor. This sits on the sending neuron and detects norepinephrine in the synapse."
What is it that "sits on the sending neuron and detects norepinephrine in the synapse"? Is it the alpha-2 NE receptor that sits on the sending neuron and detects NE in the synapse?
If so, I guess that even with a receptor sitting on it, the sending neuron can still send (the receptor doesn't cover up the neuron so to speak!)
You also wrote "By blocking this receptor with medicine (Remeron), this causes the sending neuron to release more norepinephrine."
Are you saying that Remeron blocks the alpha-2 NE receptor so it can no longer detect NE in the synapse and since the receptor can't tell if NE is in the synapse, the sending receptor releases more NE?
Thanks very much!
Posted by JohnX2 on March 22, 2002, at 0:45:52
In reply to Trying to follow what you wrote! » JohnX2, posted by Janelle on March 21, 2002, at 23:49:56
> Hi John,
>
> Okay, I THINK (repeat think!) I follow what you said about Remeron's unique action at the norepinephrine receptors.
>
> You wrote: "It [meaning Remeron] blocks a feedback receptor called the "alpha-2" norepinephrine receptor. This sits on the sending neuron and detects norepinephrine in the synapse."
>
> What is it that "sits on the sending neuron and detects norepinephrine in the synapse"? Is it the alpha-2 NE receptor that sits on the sending neuron and detects NE in the synapse?
>Basically you are correct. Most presynaptic neurons have such feedback type receptors. On the norepinephrine neurons they are generally coined "alpha-2".
> If so, I guess that even with a receptor sitting on it, the sending neuron can still send (the receptor doesn't cover up the neuron so to speak!)
That is correct.
>
> You also wrote "By blocking this receptor with medicine (Remeron), this causes the sending neuron to release more norepinephrine."
>
> Are you saying that Remeron blocks the alpha-2 NE receptor so it can no longer detect NE in the synapse and since the receptor can't tell if NE is in the synapse, the sending receptor releases more NE?
>Yes, you learn very quickly my friend.
> Thanks very much!
No problem.
Best Wishes,
John
Posted by allisonm on March 22, 2002, at 12:46:15
In reply to REMERON vs. SERZONE questions:, posted by Janelle on March 21, 2002, at 18:03:40
I have read a number of times that Remeron is less sedating at higher doses. I found 45mg sedated me VERY quickly (dangerously so) where 30mg and 15mg doses did not. I took Remeron for about two years.
I have taken Serzone for about a year now, and find it less sedating than Remeron. It still helps with sleep, but does not knock me out as Remeron could.
Posted by BarbaraCat on March 24, 2002, at 1:45:50
In reply to REMERON vs. SERZONE questions:, posted by Janelle on March 21, 2002, at 18:03:40
Hi Janelle,
It's your buddy from the other group! I've done both Serzone and Remeron and have recently increased my Remeron dosage from 15 to 30 to 45 mg. so I can tell you how it's affected me. First of all, I absolutely hated Serzone. The first week I thought I was covered in lead. That feeling went away, but never entirely. I also felt worse on it as far as the depression. It wasn't a good drug for me.Remeron (started Oct, 2001)
15 mg: Sedating, but that might be because I was just starting out and getting used to it and it is VERY sedating the first 1-2 weeks.30mg: I felt pretty good, a little fuzzy and slow moving, but it was comfortable. Had a fabulous 2 months and then it pooped. Early December I spiraled into a severe depression on it anyway, even after upping it to 60 mg. Went back down to 30mg. Early March I started lithium as an augmentor and really started feeling very good.
45 mg: The reason I went up to 45 mg is because I gained 20 lbs and reasoned that if a higher dosage kicked in the norepinephrine it might rev up my metabolism and create more motivation and enthusiasm for exercising. I've been on 45mg for about 2 weeks and I have noticed a 'brighter' feel, more energy, more drive, more alert. I also feel a little more on edge and find myself tapping my foot or chewing the inside of my cheek kind of stuff. It's harder to get to sleep also, as well as harder to wake up. I'll probably use this ooomph to settle into a good workout routine and build some other good habits, but will then try to reduce it back to 30mg so I don't drive myself into a hypomanic swing.
Hope this helps a little,
Barbara
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