Med alteration by accident

[uni]

For several years now my medications have remained the same, barring a few alterations in dosage for various reasons here and there. In March I was away for 10 days on holiday, and somehow shorted myself on the number of Remeron/mirtazipine pillls I brought along. As the dosage had been adjusted a bit in the past, I felt ok backing off and taking half a pill for some days rather than a whole one, in order to make them last.

Interestingly, and to my pleasant surprise, I did fine and there were no ill effects (normally I'm very touchy with med changes). After coming home I carried on with the lessened dosage and continued feeling fine.

Let me mention here that my pdoc and I have been through a lot over the years, and he trusts my judgement on dosage changes (although not the type of meds) if I feel one is warranted, as long as I am reasonable and let him know what I've done the next time I see him. I did exactly that a couple of weeks ago, and got the go-ahead to take 7.5 mg instead of 15 mg daily. I have to split the pills in two because 15 mg is the smallest available.

So far, so good. In fact, I feel brighter in the morning than I did before (I take the pills at bedtime due to a minor sedative effect). Plus, I once came across info that Remeron can increase cholesterol levels. I have elevated cholesterol and now take a low dose of Zocor/simvastatin for it. Call me Pollyanna, but wouldn't it be nice if this helped?

Of course, there is more daylight now, so that may be a factor, and feeling brighter on awakening may also have to do with the dread of going to work gone. I used to feel better on weekends and worse on Mondays (I have a simple calendar method of keeping track). I have to wonder if the removal of my job stresses since retiring has made a positive difference to the point of needing less medication. It's so hard to know how much of my depression over the years has been biochemical and how much has been situational. I've taked the shotgun approach and blasted it with medications plus counselling.

Anyway, we'll see how things go for a while yet because I never count my chickens when it comes to meds - too many bad experiences in the past. Anybody else have experience with this drug?

[astronaut]

Hi Uni,

I hope that the med change works for you. That would be great if the lower dose helped you feel brighter in the morning. I have no experience with the medications that you speak of. I certainly would love to lower the dose of one or two of mine though!

I know it can be difficult for some people to sort through situational and biological triggers for their depression. I haven't really had that problem. I'd say that all of my major episodes were triggered by absolutely nothing at all. This always makes me feel like hell because I feel as though I don't have a valid reason to feel so depressed when my life is going fine. It is really frustrating because I never can predict when I'm going to go into an episode because they seem so random. Of course, that's not to say that situational things haven't made my depression worse once I'm in it--that's happened too.

Hope the med change keeps working out for you! Even if the daylight is a factor in you feeling a bit brighter in the morning, it sounds like you aren't being bothered by going down on the meds anyways so that's great to hear. I'm glad you and the pdoc are on board with this together!
be well,
astronaut

[A.E.V.]

I tried remeron briefly and it did absolutely nothing for me.
I'm glad it works for you, and at a lower dosage as well! that's a nice surprise.

like astronaut, most of the time my episodes come out of the blue, for no reason.

[Re-O]

Hi Uni!

That's great that you may have been able to lessen the dose. I'm not sure of the half life of rimeron (paul is the expert on that stuff), but it sounds like you are keeping good track of things, which is crucial with a med change. What an exciting prospect! Taking less meds! I feel a wave of jealousy coming over me :P

[paul m]

Hello Uni. Interesting points. I have not taken remeron, but that doesn't matter as most drugs affect us all differently, but I can give you some generalities.

I agree with what you have said about possibly the job making a big difference. We can never tell in advance what may or may not trigger episodes. It's only by trial and error that these triggers may become apparent and like Astronaut has said, sometimes there are no prior indications.

I have a friend who has bipolar. For the last 5 yrs he has taken no meds and deals with his minor highs and lows through alternative methods. However for almost 20 years prior, he was in and out of the hospital numerous times and spent himself into bankruptcy twice.

The difference, he was in a really toxic and unhappy marriage. His ex-wife did him a great favour when she threw him out. So situational circumstances can really fuel a mental illness.

A couple of other factors may also enter into play. 1) remereon takes 4-8 wks to get fully into your system and act on a persons depression. It also takes a fair length of time to exit your system. 2) Many people do not suffer from mood swings all of the time. If I was not to take my meds for a while, there is a chance that I would have no mood swings at all for a short time. Even though I tend to rapid cycle, there have been times in my life, that I have been symptom free. Actually quit long times. The problem is knowing when those times are going to happen.

As long as both you and your doc are aware, go for it. Because of the potential of toxicity in my medications(lithium and tegretol) I raise and lower the amount I take . Because my antidepressant (wellbutrin) tend to launch me into mania I only ever take it for a very short time. However my doc is acutely aware of this and so is my spouse. As I tend to get argumentive when I get manic, I have an agreement with them both. If either of them thinks my mood is taking a drastic swing. I follow their advice first and argue about it 6 weeks later. Good Luck and Take Care. paul m

[uni]

Thanks everybody for the input!

I don't expect miracles and will continue keeping an eye on things and tracking my moods. It's difficult to know what the causes are when more than one significant thing has changed - in this case: medication, absence of job, change of season. I don't expect miracles, and continue to savour every decent/good/very good day that comes my way. If I need to increase the Remeron again, so be it, but it's kind of nice to catch a break

[uni]

Just an update. So far, things are about as usual. This is good

[paul m]

Hello Uni. That's good. I hope that it continues to work for you. Take Care. paul m

[Sweetest1]

It's always nice to be able to get by with less meds, I hope it keeps on working for you.

[uni]

Thanks Sweetest and Paul. I hope so too.

[A.E.V.]

hi uni! I'm catching up on the threads now...
are you still doing well with the lower dose?

[uni]

Sorry for taking so long to answer, Anne. I seem to be doing about the same on this dosage as on the previous one. I still get the odd speedbump, so tend to get nervous when that happens. However, this is something that seems to be "normal" for me.

I continue to track my moods and they have been pretty good. I think I'm settling down a bit from the original "retirement high", which I guess is inevitable. But still happy about it