Medications for depression comprise combinations that are determined to be suitable as per the actual type of mental disorder. Among the various types of metal health conditions and disorders, major depression is regarded as common. Preferred and frequently prescribed medications include Remeron, a branded formulation of Mirtazapine. Medically known as a tetracyclic antidepressant, it is also available in generic form. In addition to helping individuals suffering from depression, it is also used for helping patients gain weight, apart from treating insomnia.

It is important to learn all about the side effects of Remeron as a significant percent of the US population require medications for treating the conditions. Roughly 7% of the US adult population, are known to suffer from mental disorders, accounting for a staggering 17 million of adults.

How does Remeron work and deliver desired outcomes?

Remeron and its generic version, is used for treating neurological disorders, reverses weight loss, controls feelings of nausea and vomiting among patients who have undergone surgeries, and is also used to manage lack of sleep.  The medication is known to work differently when compared with other medications used for treating depression. For instance, it is known to be well tolerated with fewer side effects, and it is known to work with greater efficacy and finally it starts working in one week from the time the treatment begins.

The manner in which the formulation acts has been narrowed down to serotonergic and central adrenergic activity in the central nervous system. This is the primary action of the medication and delivers the desired antidepressant outcomes. It is known to have sedating effects which are responsible for its use in sleep management. This is attributed to its functioning as a histamine receptor agonist. The formulation also has an effect on pain receptors and this is the reason for its ability to offer pain relief.

Black box warning by the FDA

Medications are classified by the FDA as per the actions and possible outcomes. A black box warning is regarded as a high level of warning issued by the FDA. It alerts caregivers and individuals in healthcare facilities about the possible effects from long term or short term use of medication. Suicidal thoughts are possible among users of the medication, with youngsters know to harbor stronger intent. The period immediately after commencing the medication is known to pose more risks as suicidal thoughts and erratic behavior are more likely.  Any change in conduct is to be managed or mitigated at the earliest, failing which there is a likelihood of the individual’s conduct worsening.

Withdrawal symptoms are likely to be experienced by patients on antidepressants for a long term. Specific warnings about the medication clearly highlight that it is not to be discontinued abruptly, but needs to be tapered off as per medical advice. Abnormal sweating may be an early indicator of withdrawal effects of the medication. The patient may also end up confused and could experience increased dreaming. In addition the confusion mentioned above, the patient may also be anxious and could exhibit agitation without any logical reason. One of the reasons for erratic behavior or movements are shock sensations or stimuli which cause certain involuntary actions. Other withdrawal symptoms include overall tiredness, and dizzy feelings that are not linked to any other reason.

Will Remeron disrupt normal life of the patient?

Remeron is likely to disrupt normal life to a certain extent. The drowsy feeling attributed to the sedative properties can impact reflexes and the ability of the patient to be alert at work. This may make the individual unsuitable for certain types of work. For instance, driving of commercial or personal vehicles is to be avoided. Similarly, operation of equipment or machinery is also to be avoided as the capability to remain alert during the operation of the equipment may be compromised, resulting in possible hazards.

Will there be physically discernible changes when on the medication?

The medication can reverse loss of appetite and this could trigger increase in weight which could be easily visible. The patient may experience more pangs of hunger as a result of the impact on the central nervous system, and this causes increased intake. This can be countered with exercise or dietary modifications, but could effectively pose a challenge as individuals with major depression are unlikely to take up fitness related activities during depressed states. After the individual has managed to bring down depression levels, exercise and dietary modifications may be possible. Obese patients need to look at alternative medication, as additional increase in weight may result in other health complications.

Does Remeron cause the serotonin syndrome and what are the effects?

Among side effects of Remeron certain effects are regarded as serious in nature. This includes the serotonin syndrome, that is primarily an increase in serotonin levels. This is not unique to this medication but is common to all antidepressants. The actual effects of this increase may be experienced differently by patients – some may experience mild or moderate effects while others may experience serious conditions that could possibly though rarely result in fatalities.

One of the reasons for the spike in serotonin levels is intake of medications or formulations that work similarly. Serotonin is a neurotransmitter that is responsible for multiple actions, including mood stabilization, happiness and feelings that are generally associated with well-being. It works by facilitating the brain cells and the cells in the nervous system to communicate. Functions such as sleeping, eating and digestion are all linked to the neurotransmitter.

When serotonin levels spike to unusually high levels, the patient is likely to come across as agitated and confused. Conditions typically associated include hallucination, and inability to think logically.  As a result of this increase in serotonin levels, the patient may also end up with an inability to coordinate movements, and also experience some kind of uncontrollable muscle twitching. A sudden change in blood pressure levels are another possibility, and this includes increase or decrease. Other outcomes of serotonin syndrome include increased heartbeat, nausea and possible low/high grade fever.

Although known to be extremely rare, there is also the possibility of the patient slipping into a coma. Similarly, other rare occurrences include seizures, and kidney failure which may require triaging at a specialist healthcare facility.

What is the ideal dosage that can be consumed?

Remeron can be taken either alone or as a combination with other medications. The ideal or safe dosage that can be taken depends on multi[le criteria, including the actual condition that is being treated, the gender of the patient and his/her age. Patients with the same condition may have different intensities and this needs to be taken into consideration. Additionally, other medication being used for various conditions should also be assessed before prescribing the required dosage. For instance, in the event that other medications which can cause an increase in serotonin levels are being used, then it is important to alter dosage accordingly.

Other considerations include the form of the medication, and the patient’s reaction to the medication when administered the first time. Recommended dosages that are listed below are meant only for the purpose of reference about ideal dosages and should not be considered as prescriptive in nature. The actual dosage prescribed by the treating specialist will differ as per evaluation of condition and all other aggravating or attenuating factors.

Ideal dosage as per age categories

Immediate release Remeron tablets come in strengths of 15 mg, 30 mg and 45 mg. The dissolving formulations also come in similar strengths. Patients diagnosed with depression, and between the ages of 18 and 64 are generally recommended a dosage of 15 mg every day. This may vary as per circumstances and may increase, depending on the condition. However, the dosage should not exceed 45 mg every day under any circumstance. Any increase in dosage is typically carried out gradually; for instance any dosage is continued for one week or two weeks after which the dosage is increased.

Dosages are expected to be lowered as per age. For instance, elderly patients are to be administered lower dosages after a clear assessment. The kidneys of elderly individuals are unable to process any drug, and resultantly, medications remain in the body for a longer time, increasing risk of possible side effects.  Ideally, dosages are low initially, and upon observing/recording nil reactions to the dosage, the dosage is increased to the next level, and this process is repeated.  The efficacy of the drug and possible undesirable effects has not been studied in children below the age of 18 and hence, the drug is to be administered only after a very careful assessment.

Will Remeron interact with other medications?

Remeron may interact with other medications, OTC formulations, and supplements. Serious interactions include the effect caused when taken together with MAOIs; with a spike in serotonin levels in the body. This may result in the serotonin syndrome, explained in detail above. To avoid any possible interaction, it is necessary to have a gap of two weeks between both the drugs. In other words, after one drug has been stopped, the other can be started only after two weeks. Similarly, Remeron may interact with methylene blue, lithium, triptans and linezolid, causing an increase in serotonin levels.

Side effects of Remeron include interactions with benzodiazepines, triggering  greater than desired outcomes of the sedative. Similarly, Remeron may also interact with antipsychotics, antibiotics, and blood thinners/anticoagulants. Effects include changes in heart beat rhythm, increased bleeding and other effects associated with the medications.  The drug can also cause allergies such as swelling on the face, the tongue, the eyes, and rashes on the skin. Similarly, the skin may appear reddish, apart from welts forming on the skin.

 

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