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Remeron and Maxalt
Has anyone used Remeron for depression, while taking Maxalt for their migraines? I have migraines about every other day, and take 5mg maxalt for them. I was just given Remeron for depression, as the doc said i cannot take any SSRI's because of serotonin syndrome. I cannot find and interactions for Remeron, but just wondering if anyone else has tried these together. Any info appreciated.
Hello every body. I take mirtazapine 15mg tablets and have Jus been prescribed maxalt melt 10mg wafers for my bad migranes. I'm only 17 and have sufferd around 22 panic attacks/hospital trips. I really wanted to know if its suitable to take both.1 mirtazapine per night and 1 maxalt wafer per evening each night. Is this not adviseable?. PLEASE HELP, REALLY WORRIED. thanks.I
Hi,
Sorry it took me some time to respond and thank you. I am dealing with some hormone issues as well, and of course my migraines are worse at these times.
I just want to say you are an absolute angel! Thank you for all the information about you and how you cope, and for the link, i am def going to join in on that, it really opened my eyes and made me feel so much less alone.
As far as the Remeron, WOW if only a doctor could sit and explain that to me the way you did, i would have so much less fear and anxiety, and it would actually make sense!!! Now i understand what they do, and the difference between the two. I have yet to try it, because of what i am going through right now. I kinda like to be in my " normal " state when i try something new, as to not blame it on the meds if i get any side effects i will know where they are from. So i will post back if anyone is interested about the outcome. Or maybe on the other link.
But i really cant thank you enough for taking the time for me.
I hope to talk with you again soon!
Sorry it took me some time to respond and thank you. I am dealing with some hormone issues as well, and of course my migraines are worse at these times.
I just want to say you are an absolute angel! Thank you for all the information about you and how you cope, and for the link, i am def going to join in on that, it really opened my eyes and made me feel so much less alone.
As far as the Remeron, WOW if only a doctor could sit and explain that to me the way you did, i would have so much less fear and anxiety, and it would actually make sense!!! Now i understand what they do, and the difference between the two. I have yet to try it, because of what i am going through right now. I kinda like to be in my " normal " state when i try something new, as to not blame it on the meds if i get any side effects i will know where they are from. So i will post back if anyone is interested about the outcome. Or maybe on the other link.
But i really cant thank you enough for taking the time for me.
I hope to talk with you again soon!
Hi,
Thank you for responding. Yes you are right, i have experienced serotonin syndrome in the past, in 2006. I was on a high dose of Imitrex and due to the amount of migraines i have, i was taking too much. I suffer from about 16 to at the most 23 migraines a month. I have been seeing a neuro for about 6 yrs, and have had all the test, CT's, MRI's and have been on about every preventative known with out success. So, now i just take the low dose Maxalt 5mg and daily advil.
I have tried Pamelor, and elavil for preventative in the begining, because i have not always had migraines. its been about 7 yrs now, before that i just had headaches.
I am now having issues with anxiety and depression, and my doctor tells me its due to the chronic condition, and learning how to deal with it.
So when i went to see the phsyc doc, she did not want to give me any ssri's because of that. She said that their was not too many options because of this. The two that she offered were Welbutrin and Remeron, well because most of the side effects of welbutrin is what i already have promblems with, anxiety, nervousness, jittery, GI issues we chose Remeron, which she said was a tetracyclic antidepressant, but when i got home to research, i saw that it said it affects both serotonin and norepinephrin ( sp?) so i of course got anxious about it. If i did not have so many migraines monthly then i would not worry about it, but i have yet to meet anyone that has as many migraines as i do, so i feel alone in that aspect. I do not take any narcotics as they mess with my GI, i also have IBS-D, so when i do have those migraines that med's cannot help, i go to my urgent care for pain shot, which is about twice a month, onset of period and when i Ovulate.
As of date the plan for me is to try and get off the daily advil to see if that brings the migraines down, but it does not seem like a great plan in my mind as this is all i have for pain. Did i read right when u said you take triptans everyother day? If so can you tell me what triptan you take and which antidepressant? Like i said, i have not met anyone yet who has as many migraines as me.
Once again thank you for responding, it did help, and any advice on how you deal would really help me. :-)
Thank you for responding. Yes you are right, i have experienced serotonin syndrome in the past, in 2006. I was on a high dose of Imitrex and due to the amount of migraines i have, i was taking too much. I suffer from about 16 to at the most 23 migraines a month. I have been seeing a neuro for about 6 yrs, and have had all the test, CT's, MRI's and have been on about every preventative known with out success. So, now i just take the low dose Maxalt 5mg and daily advil.
I have tried Pamelor, and elavil for preventative in the begining, because i have not always had migraines. its been about 7 yrs now, before that i just had headaches.
I am now having issues with anxiety and depression, and my doctor tells me its due to the chronic condition, and learning how to deal with it.
So when i went to see the phsyc doc, she did not want to give me any ssri's because of that. She said that their was not too many options because of this. The two that she offered were Welbutrin and Remeron, well because most of the side effects of welbutrin is what i already have promblems with, anxiety, nervousness, jittery, GI issues we chose Remeron, which she said was a tetracyclic antidepressant, but when i got home to research, i saw that it said it affects both serotonin and norepinephrin ( sp?) so i of course got anxious about it. If i did not have so many migraines monthly then i would not worry about it, but i have yet to meet anyone that has as many migraines as i do, so i feel alone in that aspect. I do not take any narcotics as they mess with my GI, i also have IBS-D, so when i do have those migraines that med's cannot help, i go to my urgent care for pain shot, which is about twice a month, onset of period and when i Ovulate.
As of date the plan for me is to try and get off the daily advil to see if that brings the migraines down, but it does not seem like a great plan in my mind as this is all i have for pain. Did i read right when u said you take triptans everyother day? If so can you tell me what triptan you take and which antidepressant? Like i said, i have not met anyone yet who has as many migraines as me.
Once again thank you for responding, it did help, and any advice on how you deal would really help me. :-)
Hi tiansoph,
I am not a nurse or a doctor, but we do have a doctor that visits this thread frequently. Rowena Santos, MD, will likely answer your question shortly.
Even though I am not a doctor or a nurse, I can tell you what I know about both of the medications you are taking. Mirtazapine is a tetracyclic antidepressant. This specific medication cannot cause Serotonin Syndrome on its own. If you have experienced Serotonin Syndrome in the past, it is possible that your doctor picked this medication specifically because there is no way it can cause Serotonin Syndrome.
According to NAMI (The National Alliance on Mental Illness), combining Remeron and Triptans can increase the risk of Serotonin Syndrome but this is rare.
I am curious, is your doctor worried about Serotonin Syndrome because you have suffered from Serotonin Syndrome before? Or is your doctor worried about a possible interaction between Triptans and Antidepressants?
It is possible, but very unlikely, for triptans and most antidepressants, when used at the same time, to cause Serotonin Syndrome. This rarely happens. People are prescribed antidepressants in combination with triptans all the time. I personally take an antidepressant and I also take triptans at least every other day. The reason that they list Serotonin Syndrome as a warning is because it is possible, but not because it is a common-side effect. Since it is possible, it is important to know the warning signs and symptoms of Serotonin Syndrome so that you can seek emergency medical attention if happens. The warning is there not to stop doctors from prescribing the two medications in combination, but it is there to warn patients of the symptoms to watch out for in the very unlikely case that it happens.
Hope that helps!
- marilee
I am not a nurse or a doctor, but we do have a doctor that visits this thread frequently. Rowena Santos, MD, will likely answer your question shortly.
Even though I am not a doctor or a nurse, I can tell you what I know about both of the medications you are taking. Mirtazapine is a tetracyclic antidepressant. This specific medication cannot cause Serotonin Syndrome on its own. If you have experienced Serotonin Syndrome in the past, it is possible that your doctor picked this medication specifically because there is no way it can cause Serotonin Syndrome.
According to NAMI (The National Alliance on Mental Illness), combining Remeron and Triptans can increase the risk of Serotonin Syndrome but this is rare.
I am curious, is your doctor worried about Serotonin Syndrome because you have suffered from Serotonin Syndrome before? Or is your doctor worried about a possible interaction between Triptans and Antidepressants?
It is possible, but very unlikely, for triptans and most antidepressants, when used at the same time, to cause Serotonin Syndrome. This rarely happens. People are prescribed antidepressants in combination with triptans all the time. I personally take an antidepressant and I also take triptans at least every other day. The reason that they list Serotonin Syndrome as a warning is because it is possible, but not because it is a common-side effect. Since it is possible, it is important to know the warning signs and symptoms of Serotonin Syndrome so that you can seek emergency medical attention if happens. The warning is there not to stop doctors from prescribing the two medications in combination, but it is there to warn patients of the symptoms to watch out for in the very unlikely case that it happens.
Hope that helps!
- marilee
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I am so sorry to hear how severely your migraines have effected your life and well-being. Migraines can be very disabling, especially when they are out of control.
I have chronic migraines, that means I have at least 15 migraines a month. Depending on the month, I might get them daily or I might only have around 15. You should join our Migraineurs Support Group on medhelp, you will find many more people with chronic migraines (15+ a month) or status migrainosus (migraines that last at least 3 days without any relief) or chronic status migrainosus (a never-ending migraine, with no relief, for months or years).
http://www.medhelp.org/forums/Migraineurs-Support/show/488
I sometimes feel very similar to you I think, because I don't know very many people in person who have chronic migraines. Since becoming more active in learning about the disease and advocating for those who also have the disease, I have begun to meet more people in person who have chronic migraines. Still, it can feel lonely sometimes. That is why the internet is such a wonderful place, because in the whole world, there are actually quite a lot of people who suffer from severe chronic migraines and the internet allows them all to meet and share their stories.
I currently take Wellbutrin. It has been the only antidepressant that I have found to be successful without side effects. I also take lithium (it helps with the migraines), and that is sort of an antidepressant but not really.
As for triptans, my regular triptan is Zomig Nasal Spray. On average, I use Zomig Nasal Spray every other day. But, there are times where I will go 3 or 4 days without needing to use it. And there are also times where I will use it every day for sometimes up to a week.
My Zomig Nasal Spray works about 90% of the time and I have no side effects either, except sometimes if I am using it every single day then my nose will get raw or I will get nose bleeds. I pretty much love my Zomig. But, sometimes it doesn't work. Usually when I get 9/10 or 10/10 headaches, it will not work. The kind of headaches where I stop being me. The kind of headaches where I am at risk to myself (I've accidentally harmed myself before when trying to stop the pain). The kind of headaches I used to always go to the hospital for. Anyway, it's those headaches where the Zomig does nothing. For those headaches, I use Imitrex Injection. It works almost immediately, but the side-effects will knock me out for at least half an hour after using it. Like most people who experience side-effects with Imitrex, I get a rash, a racing heart beat and a feeling of heaviness in my chest (like asthma). The side-effects seem like nothing to me though, because they go away quickly (usually in half an hour, sometimes it takes a few hours) and they are nothing compared to the migraines.
I also often use Naproxen in combination with either of my triptans. It is an NSAID like advil is, but there is almost no chance that Naproxen will cause rebound headaches. And, I sometimes will use Metoclopramide along with either of my triptans. Metoclopramide makes the triptans more effective, so I take it when the triptans fail or when they are not completely relieving my symptoms. The Metoclopramide is an antiemetic so it stops nausea and vomiting, and so I always take it if I have nausea with my migraine. You may want to look into metoclopramide, because you may find that your triptan works better when you take them in combination, and it will also increase the effectiveness of the advil you take. You mention GI problems too, and since metoclopramide is an antiemetic, it shouldn't give you an GI side-effects, if anything it should improve your existing GI symptoms.
When I was taking the triptan Axert, and I was on a different antidepressant, Effexor... I once got very sick and my doctor thought it might have been Seretonin Syndrome and changed my triptan to Zomig (Axert only comes in a very high dose). I never had any problems with the Zomig, and I took it while I was on the Effexor for a very long time. My neurologist did not agree with my doctor's diagnosis for Serotonin Syndrome, and was not worried about prescribing me the Imitrex Injection for my severe migraines. So far, I have had absolutely no problems with either triptan. Serotonin Syndrome is very rare, and my neurologist was likely right that the combination of Axert and Effexor did not cause Serotonin Syndrome in my case. But! You actually did have confirmed Serotonin Syndrome once, so I am not suggesting that you should throw caution to the wind and mix antidepressants with your triptans. A very small number of people are just at risk for Serotonin Syndrome, and unfortunately you may just be one of those people. But, you are being careful to make sure you aren't putting yourself at risk for that again, and that's the best thing you can do if you've had Serotonin Syndrome in the past.
You are right that Remeron effects both serotonin and norepinephrine, but it does so in a very different way then SSRIs. Remeron works by acting as an antagonist on the serotonin receptors and as an inhibitor of the norepinephrine transporters. Whereas SSRIs are reuptake inhibitors. That means that they act on the serotonin transmitters. A SSRI tells the serotonin transmitters to stop removing serotonin from around the serotonin receptors, the result is that the serotonin sticks around the receptors longer than it normally would, meaning the serotonin can keep stimulating the receptors and i also think it means there is more serotonin around the receptors to stimulate them too. Remeron it quite different, it goes to the receptor and sort of just sits beside it or on it, depending on how you want to think about it. Receptors wait around to be given orders. So, the Remeron hangs out next to the serotonin receptors and blocks the regular orders from getting through (or doesn't allow as many of the orders to get through). So, you can think of SSRIs working like a sponge and Remeron working like a shield. If you think of a kitchen sponge, it can only soak up so much liquid before it stops being useful. It's the same with SSRIs, a sponge holding a bit of serotonin will make you happy but a sponge so saturated with serotonin that it can't hold anymore, well that will make you feel extremely awful and ill. Remeron is just a shield attached to the serotonin receptors, but it can't soak up any extra serotonin because a shield doesn't soak things up.
- marilee