June 11, 2010
Disclaimer: this is a legitimate use of mirtazapine by prescription without abuse or intent to abuse the drug.
I've been prescribed mirtazapine (Remeron) initially by the Mental Health Centre's shrink, 60 tablets @ 15 mg each for depression. When I first took Remeron, I felt tired (sedated) and fell asleep. The next day it took me two hours to wake up. That was May 12.
Over the next few weeks, I got used to the sedation, and took the dose as described: 15 mg at bedtime, 7.5 mg on rising and 7.5 mg 4-6 hours later.
Currently, with the Remeron regiment of 30 mg a day in 4 divided doses, I am in top mental condition compared to a month ago, 3 months ago and even 6 months ago. With the Remeron came periods of fatigue where it's best not to read a book but just await the passing of tiredness.
However, this drug helped me deal with anxiety, which I tested by facing my fear of heights by crossing a pedestrian bridge without any sign of fear.
Yet most of the day I am inspired to read a lot (first 6, then 5, and now 4 books). Once I got used to the tiredness, my self-motivation increased. This may have been due to both the change in season from spring to summer, but mirtazapine augmented my normally calm exterior and freed me of depression.
It's been 4 weeks or so since I filled my first prescription of 60 15 mg Remeron, of which are 22 pills remaining.
During those four weeks, I went from 106 lbs to 114 lbs. So due to the mirtazapine, my weight has increased by almost 8 percent. At this rate, in a year I would have gained over 100 lbs. (20140126: I now weigh 127 lbs, but stopped mirtazapine in December 2012. Going to bed late may contribute to weight gain. YMMV)
So, a diet plan is in order; in short, I need an energy-burning exercise regime to counteract the weight I am packing on. Since I gain about 1 kg every week, this means I consume about 2000+ calories a day and retain 6-7 percent of those calories as body fat.
Most definitely those carbs need to be dumped for more healthy fats and protein. (20150126: It seems like Remeron might cause OCD.)
Hunger due to anticholinergic effect caused by mirtazapine (Remeron) usually has a psychological basis.
Usually we stuff our mouths because we hunger for companionship. This side effect in essence may mean that antihistamines may worsen feelings of depression and loneliness. However, that hunger could be displaced as increased self esteem and attendant self confidence i.e. 'gives you balls' when feelings of emptiness are counteracted by realization that emptiness is the root of interdependence.
Thus, motivation to moderate hunger may be sought through social networking, mainly off-line. In becoming sociable, one may learn how to control one's eating habits.
But I digress.
Remeron may improve your mind enough to make sense of depression and addiction. Anxiety is indirectly relieved by Remeron; more likely the person's mental habits are more at fault here than the drug. or both anxiety and depression may be affects of the human condition.
As for depression, the almost absolute calm which Remeron brings to the mental health consumer may be mistaken for depression because one may forget that happiness is the product of one's own mind, rather than the result of external circumstances.
Most definitely, this is better than using Remeron recreationally.
Update: November 21, 2012
Everything about mirtazapine and its anti-histamine effects are true. After tasting it for 6 months, IMO it has strong sedative properties which work fine for relieving depression and anxiety, which leads to preventing psychoses.
However, the rest of the description of mirtazapine at Wikipedia is plain horse shit.
Why? Because it's speculative and not based on the horrible but messy testing of rats and other creatures that can't talk.
The mirtazapine related drugs are mainly sedatives of the antihistamine class which do work for mild depression and anxiety mainly by sedation.
The other side effect of anti-histamine drugs is in large doses, the dopamine and noradrenaline effect kick in but without any psychoses because you need lots of insomnia to see things and hear things.
Though you do get a little of the physical effects which is similar to anti-psychotics side effect of akathasia but reversible. Akathasia is the worst case of anxiety with physical symptoms. In my case, when I was anxious, I'd rotate my wrists and twiddle my thumbs. I did that a lot in crowds with my hands in my jacket pockets.
However, I had the experience of listening to a psychiatrist describe SSRI side effects when mirtazapine has no such thing. The serotonin response to an SSRI is anxiety, nervousness, nausea and sometimes even vomiting.
Mirtazapine, however, is used to prevent those symptoms as it is a strong but safe sedative, making it superior to OTC antihistamines. In fact, it is used as a sedative to counteract SSRI side effects.
So forget the Wikipedia description of mirtazapine regarding the speculation of how it works. Its strong antihistamine effect makes whatever it does for the effect on noradrenalin and dopamine seem weak in comparison.
Even so, as I said before, social interaction in public relieves most effects of anxiety but subtly motivates one to stop choosing behaviors that lead to depression, including sleeping until afternoon and staying up all night.
YMMV
Originally posted on June 11, 2010 at 0228H PDT
Wikipedia article on mirtazapine:
https://en.wikipedia.org/wiki/mirtazapine
Showing posts with label mirtazapine. Show all posts
Showing posts with label mirtazapine. Show all posts
20140111
My Mental Health So Far (satire)
When I reflect on the borderline personality disorder diagnosis I was given over 20 years ago, perhaps it was only accurate in 1991.
After discussing the diagnosis with my doctor, we decided to preserve my mental health by not opting for medication. At age 33, I was still young and immature for my age.
Overall though, my delayed maturity was due mainly to my limited social experience before moving out of my parents' home.
At age 39 I left home to live on my own. It's been over 15 years now that I've lived independently of my parents, but only five years since I have developed a mature understanding of the roles my siblings (one older brother, one younger sister) and my parents played in my emotional and psychological development.
During that time, I lost a friend in 2006 to pancreatic cancer and my father in 2007 to old age. As well, I met and fell in love with four different women in 1994, 2000, 2001 and 2007.
Today I'm sure the borderline personality disorder is in remission.
By the end of 2012, I have been in remission from depression that lasted from 2009 to 2011. From 2010 to 2012, I chose psychotherapy combined with medication of my choosing to see if it would help me.
From my perspective, I am sure that psychotherapy was helpful in the beginning. Yet it was becoming less useful over time due to my unwillingness to fully commit to total disclosure. At some point near its end, I developed a fear that continued therapy would undo the improvement in my life.
Even so, I learned a lot from my psychotherapist and my choice in medication. All that can be confirmed about medication is that mirtazapine is a strong sedative and did what it was meant to do (relieve depression).
After discontinuing mirtazapine in 2012, I have relied on gabapentin two 100 mg capsules daily and one 10 mg tablet of flexeril to aid in relief of insomnia.
Gabapentin (Neurontin) is used for neuralgic pain in low doses. Flexeril (cyclobenzaprine) is a muscle relaxant with sedative effects is used to reduce pain for the osteoarthrosis in my left shoulder. Together, both drugs reduce the subtle effects of pain in my body to help me to sleep at night.
After doing a thorough research on borderline personality disorder, I know that I have outgrown a lot of its symptoms over time. That include no recent incidents of self harm and only rare occurrences of impulsivity.
As for idealization and devaluation of others, alternating between high positive regard and great disappointment, it rarely occurs. Instead I maintain a high positive regard for most of my friends and as much positive regard for my GooglePlus followers.
Additionally, I know that the diagnosis of borderline personality disorder implies the personality of a person is flawed. In response, I feel that perhaps the psychiatrists who voted on keeping borderline personality disorder in DSM-V would rather have the ignorant believe in the myth of a flawed personality associated with this debilitating personality disorder than actually overcome the stigma associated with it.
Indeed, I do not believe that my personality is flawed since it is based on myth rather than fact. Rather, a diagnosis of borderline personality disorder may be based on a lack of information about the person being diagnosed including cultural heritage.
Had I been exposed to medication earlier, I am uncertain that it could have helped me at all. For my research on various medications led me to conclude that very little of the medical trials on antidepressants, anti-psychotics, and sedatives included enough Asian volunteers to validate their safety.
I feel that whenever flaws in my personality appear, it is when I am stressed. A person truly cannot isolate himself from the world for long. Even being at home for two days would lead me to develop insomnia. In order to remedy such a situation, I will spend more time away from my computer in the future.
As for now, I would rate my mental health as good with room for improvement.
However, regarding bipolar disorder and other mood disorders, medication and psychotherapy may be warranted when coping strategies do not work.
In my case; I rely on exercise and meditation as coping strategies to relieve stress.
For exercise, I get outside to walk up to five days of the week. Meditation only takes up about 15 minutes of my day.
My hobbies are listening and making music, reading, and writing on my blog.
As for computers, I enjoy both my time on-line and especially off-line. Indeed, being away from the computer is a relief. As well, not using my phone is a bigger relief than using it used to be.
For the moment, because of insomnia, I will consider sleep the best coping strategy of all.
After discussing the diagnosis with my doctor, we decided to preserve my mental health by not opting for medication. At age 33, I was still young and immature for my age.
Overall though, my delayed maturity was due mainly to my limited social experience before moving out of my parents' home.
At age 39 I left home to live on my own. It's been over 15 years now that I've lived independently of my parents, but only five years since I have developed a mature understanding of the roles my siblings (one older brother, one younger sister) and my parents played in my emotional and psychological development.
During that time, I lost a friend in 2006 to pancreatic cancer and my father in 2007 to old age. As well, I met and fell in love with four different women in 1994, 2000, 2001 and 2007.
Today I'm sure the borderline personality disorder is in remission.
By the end of 2012, I have been in remission from depression that lasted from 2009 to 2011. From 2010 to 2012, I chose psychotherapy combined with medication of my choosing to see if it would help me.
From my perspective, I am sure that psychotherapy was helpful in the beginning. Yet it was becoming less useful over time due to my unwillingness to fully commit to total disclosure. At some point near its end, I developed a fear that continued therapy would undo the improvement in my life.
Even so, I learned a lot from my psychotherapist and my choice in medication. All that can be confirmed about medication is that mirtazapine is a strong sedative and did what it was meant to do (relieve depression).
After discontinuing mirtazapine in 2012, I have relied on gabapentin two 100 mg capsules daily and one 10 mg tablet of flexeril to aid in relief of insomnia.
Gabapentin (Neurontin) is used for neuralgic pain in low doses. Flexeril (cyclobenzaprine) is a muscle relaxant with sedative effects is used to reduce pain for the osteoarthrosis in my left shoulder. Together, both drugs reduce the subtle effects of pain in my body to help me to sleep at night.
After doing a thorough research on borderline personality disorder, I know that I have outgrown a lot of its symptoms over time. That include no recent incidents of self harm and only rare occurrences of impulsivity.
As for idealization and devaluation of others, alternating between high positive regard and great disappointment, it rarely occurs. Instead I maintain a high positive regard for most of my friends and as much positive regard for my GooglePlus followers.
Additionally, I know that the diagnosis of borderline personality disorder implies the personality of a person is flawed. In response, I feel that perhaps the psychiatrists who voted on keeping borderline personality disorder in DSM-V would rather have the ignorant believe in the myth of a flawed personality associated with this debilitating personality disorder than actually overcome the stigma associated with it.
Indeed, I do not believe that my personality is flawed since it is based on myth rather than fact. Rather, a diagnosis of borderline personality disorder may be based on a lack of information about the person being diagnosed including cultural heritage.
Had I been exposed to medication earlier, I am uncertain that it could have helped me at all. For my research on various medications led me to conclude that very little of the medical trials on antidepressants, anti-psychotics, and sedatives included enough Asian volunteers to validate their safety.
I feel that whenever flaws in my personality appear, it is when I am stressed. A person truly cannot isolate himself from the world for long. Even being at home for two days would lead me to develop insomnia. In order to remedy such a situation, I will spend more time away from my computer in the future.
As for now, I would rate my mental health as good with room for improvement.
However, regarding bipolar disorder and other mood disorders, medication and psychotherapy may be warranted when coping strategies do not work.
In my case; I rely on exercise and meditation as coping strategies to relieve stress.
For exercise, I get outside to walk up to five days of the week. Meditation only takes up about 15 minutes of my day.
My hobbies are listening and making music, reading, and writing on my blog.
As for computers, I enjoy both my time on-line and especially off-line. Indeed, being away from the computer is a relief. As well, not using my phone is a bigger relief than using it used to be.
For the moment, because of insomnia, I will consider sleep the best coping strategy of all.
20130505
Update on my Medication: Sleep Deprivation versus Adequate Sleep
Psychiatry is the only profession where sometimes the doctors prescribing the drugs actually have never had any experience with them. My experience with mirtazapine is a good example of this: the psychiatrist described side effects of SSRI antidepressants which mirtazapine actually moderates due to its sedative effects.
As well, mirtazapine's sedation makes it possible to feel sociable because it's not a tranquilizer.
Though, my current usage of 200 mg of gabapentin and 10 mg of flexeril at bedtime is an improvement over the mirtazapine since even when I miss doses, it doesn't impact sleep quality. The only exception to this is when I do graveyard shifts.
In response to sleep deprivation in recent memory, I experienced a few pseudo-hallucinations, none of which actually were severe enough to warrant more than the usual rationalizations I use to treat them as exaggerations of explainable phenomena.
The pseudo-hallucination consisted of "seeing" the electric field of the power cord to my computer. Being well-rested now, I can explain this in two parts: when seen by the eyes, a black power cord could leave an after-image of lighter color. In my sleep-deprived state of mind, it is possible for the mind to add colorful detail that gives the impression of "seeing" the electric field of the power cord.
Though, I'd be happier to see a Buddha appear out of the blue. That's never happened to me ever. Most likely, this is because a Buddha is a metaphysical phenomenon while my pseudo-hallucination is the result of an overtired mind playing with a physical phenomenon.
Given the power of the mind when tired to conjure a hallucination I knew not to be real — which is what a pseudo-hallucination is — imagine what the mind could do when well-rested: analyze the recent experience of sleep deprivation and provide a rational explanation for it.
To explain how this has come about, I am going to attribute this to two causes: getting daily exercise during work shifts this week and getting regular sleep.
As well, mirtazapine's sedation makes it possible to feel sociable because it's not a tranquilizer.
Though, my current usage of 200 mg of gabapentin and 10 mg of flexeril at bedtime is an improvement over the mirtazapine since even when I miss doses, it doesn't impact sleep quality. The only exception to this is when I do graveyard shifts.
In response to sleep deprivation in recent memory, I experienced a few pseudo-hallucinations, none of which actually were severe enough to warrant more than the usual rationalizations I use to treat them as exaggerations of explainable phenomena.
The pseudo-hallucination consisted of "seeing" the electric field of the power cord to my computer. Being well-rested now, I can explain this in two parts: when seen by the eyes, a black power cord could leave an after-image of lighter color. In my sleep-deprived state of mind, it is possible for the mind to add colorful detail that gives the impression of "seeing" the electric field of the power cord.
Though, I'd be happier to see a Buddha appear out of the blue. That's never happened to me ever. Most likely, this is because a Buddha is a metaphysical phenomenon while my pseudo-hallucination is the result of an overtired mind playing with a physical phenomenon.
Given the power of the mind when tired to conjure a hallucination I knew not to be real — which is what a pseudo-hallucination is — imagine what the mind could do when well-rested: analyze the recent experience of sleep deprivation and provide a rational explanation for it.
To explain how this has come about, I am going to attribute this to two causes: getting daily exercise during work shifts this week and getting regular sleep.
20130204
Update on my Meds: Not for Insomnia
OK, just so you know, neither gabapentin nor cyclobenzaprine cause sleep in insomniacs.
I'm pretty sure you'd need harder stuff to promote sleep, like say 15 mg mirtazapine.
However, I'll stick to the current medications prescribed because of the strong sedative effect of mirtazapine.
I'm pretty sure you'd need harder stuff to promote sleep, like say 15 mg mirtazapine.
However, I'll stick to the current medications prescribed because of the strong sedative effect of mirtazapine.
20130111
Good Bye Personality Disorder, Hello Neurosis
Around 1992, I was diagnosed with borderline personality disorder. However, after discussion of the matter with my doctor, I decided not to seek medication.
Twenty years later, that diagnosis does not define me at all. While I can relate to fear, anxiety, insomnia, and hypomania, I cannot relate to mania and psychosis. For it turns out that when I enter the hypomanic phase, I become sociable and outgoing.
While I am anti-psychiatry, I am not anti-medication. Since both cyclobenzaprine and gabapentin are not used like the usual psychopharamaceuticals, I don't consider them in the same light as sleep aids.
I shall continue to use them because nine times out of ten, they would as directed (10 mg of cyclobenzaprine and 2 x 100 mg of gabapentin at bedtime). Otherwise, I'm overproductive and on a roll until I sleep it off.
When I was on mirtazapine three years ago, it acted like a strong sedative. Today I won't touch it again.
Aside from medication I try to get out at least four to five times a week.
When I get the urge to indulge in my photography hobby I get right into it. That hobby has helped me a lot.
So, rather than borderline personality disorder, I'm going with neurosis. Furthermore, because neuroses are no longer in the DSM, the medications I am using now help with sleep quality.
Neuroses are associated with distress, which points to mental suffering. While medication provides restful sedation, meditation helps achieve the calm mind to aid in gathering insight into one's distress.
In fact, once a person learns the basics of meditation, she can practice anytime and anywhere to clear her mind and bring an end to her suffering eventually.
Personally I tend to see suffering as inspiration to meditate and discover what gifts it has hidden away.
In that light, neuroses fade away, and reveal curiosity about what's really troubling me, and inspires me to write about it further exposing my neuroses to light until they become something I can control like fear, anxiety, and even insomnia.
This whole process of meditation is what I call the only true mind control. This kind of control is self-taught. This implies that meditation can be learned by any one.
Also, all the aspects of neurosis could be seen as gifts hidden behind suffering. Fear too becomes useful because it appears when one is under threat, be it by stress or by physical threat. Stress itself may be harder to escape than a physical threat, only if we listen to the fear rather than the voice of reason.
Often that voice of reason is saying "Look for the hiden gifts". So for me, the most expedient way of handling stress is to welcome it nto my life. It could be just as easy ass saying quietly, "Thank you stress!" Even greeting neuroses could do wonders to relieve distress.
In essence, that is the second part of meditation, when you are calm in mind and ready to handle stress, it would be just the time to observe your thoughts to see how they arise to form your fear. Once you do that, then you could stop listening to them by listening to yourself breathe, and if you're beyond that, get out and exercise to break the spell of neurosis.
For it starts with watching your breath and it ends very well...
Twenty years later, that diagnosis does not define me at all. While I can relate to fear, anxiety, insomnia, and hypomania, I cannot relate to mania and psychosis. For it turns out that when I enter the hypomanic phase, I become sociable and outgoing.
While I am anti-psychiatry, I am not anti-medication. Since both cyclobenzaprine and gabapentin are not used like the usual psychopharamaceuticals, I don't consider them in the same light as sleep aids.
I shall continue to use them because nine times out of ten, they would as directed (10 mg of cyclobenzaprine and 2 x 100 mg of gabapentin at bedtime). Otherwise, I'm overproductive and on a roll until I sleep it off.
When I was on mirtazapine three years ago, it acted like a strong sedative. Today I won't touch it again.
Aside from medication I try to get out at least four to five times a week.
When I get the urge to indulge in my photography hobby I get right into it. That hobby has helped me a lot.
So, rather than borderline personality disorder, I'm going with neurosis. Furthermore, because neuroses are no longer in the DSM, the medications I am using now help with sleep quality.
Neuroses are associated with distress, which points to mental suffering. While medication provides restful sedation, meditation helps achieve the calm mind to aid in gathering insight into one's distress.
In fact, once a person learns the basics of meditation, she can practice anytime and anywhere to clear her mind and bring an end to her suffering eventually.
Personally I tend to see suffering as inspiration to meditate and discover what gifts it has hidden away.
In that light, neuroses fade away, and reveal curiosity about what's really troubling me, and inspires me to write about it further exposing my neuroses to light until they become something I can control like fear, anxiety, and even insomnia.
This whole process of meditation is what I call the only true mind control. This kind of control is self-taught. This implies that meditation can be learned by any one.
Also, all the aspects of neurosis could be seen as gifts hidden behind suffering. Fear too becomes useful because it appears when one is under threat, be it by stress or by physical threat. Stress itself may be harder to escape than a physical threat, only if we listen to the fear rather than the voice of reason.
Often that voice of reason is saying "Look for the hiden gifts". So for me, the most expedient way of handling stress is to welcome it nto my life. It could be just as easy ass saying quietly, "Thank you stress!" Even greeting neuroses could do wonders to relieve distress.
In essence, that is the second part of meditation, when you are calm in mind and ready to handle stress, it would be just the time to observe your thoughts to see how they arise to form your fear. Once you do that, then you could stop listening to them by listening to yourself breathe, and if you're beyond that, get out and exercise to break the spell of neurosis.
For it starts with watching your breath and it ends very well...
20110228
Insomnia Inspires me
2/28/2011: Insomnia inspires me to post this blog. While I am grateful for this inspiration, my ego has also reached for a dangerous solution to the fatigue: mirtazapine to sedate me and caffeine-laced beverages to keep me hour going.
This is not my choice: sedatives are for bedtime, and caffeine does not replace lost sleep.
So once this blog is posted, I shall yet attempt to sleep.
This is not my choice: sedatives are for bedtime, and caffeine does not replace lost sleep.
So once this blog is posted, I shall yet attempt to sleep.
20110208
Flexeril and Its Antidepressant Effects due to Antihistimine Properties
Monday morning I got up early enough to visit my doctor. Due to my insomnia, I had delayed a follow-up visit to him while tapering down to one tablet of mirtazapine when needed i.e. when I need a good sleep before morning.
After 5 minutes of talking to my doctor, he recommended stretching exercises - and I countered with "I practice tai chi". So he suggested cyclobenzaprine (flexeril), a tricyclic antidepressant with strong muscle relaxant properties i.e. another antihistamine chemically different from benadryl and mirtazapine.
This drug has a slow onset of 2-6 hours but lasts for up to 20 hours.
I know because after I got home around 11 PM, it took me about 2 hours before the first effects hit me, but had taken one tablet about 8PM. By 4AM I was off to bed.
It's unknown if dissolving the tablet in my mouth leads to this delayed effect. Then most of Tuesday was spent in bed. I'd only gotten up around 5 PM.
There may be a synergy with alcohol, because I slowly sipped a Colt 45 circa 9.45 PM at a friend's place and was out of there by 10:25 PM.
However, I felt no alcohol buzz; this may have been due to smoking a couple cigarettes for most of the time at my friend's place. In fact, I believe nicotine may have been the protective factor, as it kept me alert and less likely to yield to both alcohol's and flexeril's sedative properties.
When I awoke during the time before 5 PM, I just felt the need for more sleep. This, most likely, was a "hangover" effect due to the combination of alcohol with flexeril and trace amounts of mirtazapine.
Therefore, the mixing of liberal amounts of alcohol and/or other CNS depressants with Flexeril is not recommended. This includes mirtazapine and other psychiatric medication. Also included is gabapentin and other anti-epileptic drugs.
Updated: 20111116.1625
Flexeril is a muscle relaxant which has sedation as one of its side-effects. Currently, I use flexeril 10 mg daily.
Mirtazapine is being marketed as an antidepressant, however, it has antihistamine side effect of sedation in low doses. I used to take this medication at 2 doses of 15 mg daily. Over a year after I first wrote this article, I no longer take mirtazapine.
Gabapentin is used for nerve pain and is used mainly to control seizures in epilepsy in high doses. Currently I use it for its ability to reduce anxiety at 2 doses at 100 mg per capsule.
20121225.0841
Currently I use 10 mg of flexeril and 200 mg of gabapentin at bedtime. The gabapentin helps improve the ability to enter deep sleep and the flexeril helps me to fall to sleep.
After 5 minutes of talking to my doctor, he recommended stretching exercises - and I countered with "I practice tai chi". So he suggested cyclobenzaprine (flexeril), a tricyclic antidepressant with strong muscle relaxant properties i.e. another antihistamine chemically different from benadryl and mirtazapine.
This drug has a slow onset of 2-6 hours but lasts for up to 20 hours.
I know because after I got home around 11 PM, it took me about 2 hours before the first effects hit me, but had taken one tablet about 8PM. By 4AM I was off to bed.
It's unknown if dissolving the tablet in my mouth leads to this delayed effect. Then most of Tuesday was spent in bed. I'd only gotten up around 5 PM.
There may be a synergy with alcohol, because I slowly sipped a Colt 45 circa 9.45 PM at a friend's place and was out of there by 10:25 PM.
However, I felt no alcohol buzz; this may have been due to smoking a couple cigarettes for most of the time at my friend's place. In fact, I believe nicotine may have been the protective factor, as it kept me alert and less likely to yield to both alcohol's and flexeril's sedative properties.
When I awoke during the time before 5 PM, I just felt the need for more sleep. This, most likely, was a "hangover" effect due to the combination of alcohol with flexeril and trace amounts of mirtazapine.
Therefore, the mixing of liberal amounts of alcohol and/or other CNS depressants with Flexeril is not recommended. This includes mirtazapine and other psychiatric medication. Also included is gabapentin and other anti-epileptic drugs.
Updated: 20111116.1625
Flexeril is a muscle relaxant which has sedation as one of its side-effects. Currently, I use flexeril 10 mg daily.
Mirtazapine is being marketed as an antidepressant, however, it has antihistamine side effect of sedation in low doses. I used to take this medication at 2 doses of 15 mg daily. Over a year after I first wrote this article, I no longer take mirtazapine.
Gabapentin is used for nerve pain and is used mainly to control seizures in epilepsy in high doses. Currently I use it for its ability to reduce anxiety at 2 doses at 100 mg per capsule.
20121225.0841
Currently I use 10 mg of flexeril and 200 mg of gabapentin at bedtime. The gabapentin helps improve the ability to enter deep sleep and the flexeril helps me to fall to sleep.
20110101
How I Overcame the Fear of Medication
I used to be afraid of medication until I tried them.
Now they have made it harder for nicotine to addict me, and even harder for THC to make me anxious and paranoid.
I'm even wise to the meth BS. Why would anyone take crappy street amphetamines when there are ADHD meds which are safer and less toxic when used as directed?
As well, if you seriously used nicotine, then you'd have an over-the-counter antidepressant in inhalant format called cigarettes. In low doses nicotine is a stimulant; in high doses, it is as effective as a first-generation anti-histamine in sedation and "calming the nerves".
The good news is, THC still is a sedative in low doses. The terrific news is, mirtazapine blocks the munchies because as an antihistamine, it's an effective sedative with munchies as side effect. :p
Of course, I'd never mix alcohol or hard drugs with my medication, because that's a waste of my effort to manage my disease, which is depression.
Since humor is a mature way of dealing with uncomfortable feelings of anxiety, fear and dread, I plan on dealing with depression with humor to counteract any negativity arising from those feelings.
In this way I have overcome my initial fear of medication by choosing which of them I wish to take. I chose mirtazapine because of its safety profile for sedative action, and chose gabapentin of its safety in relieving pain and helping me to express myself.
However, this blog entry does not represent the full picture of depression. It only represents the protective effect of mirtazapine and gabapentin on my brain. They are more useful than cigarettes and marijuana, because of their safety profile. Yet I would be foolish to solely rely on them, for they are not magic bullets.
References:
Nicotine's psychological effects: http://en.wikipedia.org/wiki/Nicotine#Psychoactive_effects
Gabapentin and alcohol withdrawal syndrome: Am J Health-Syst Pharm—Vol 65 Jun 1, 2008
p. 1039
Comparison of Gabapentin and Phenobarbital for treatment of alcohol withdrawal: DOI: 10.1080/10550490500419110
Comparison of Gabapentin and bupropion SR for stopping smoking: Nicotine & Tobacco Research Volume 7, Number 5 (October 2005) 809–813
Gabapentin for stopping smoking: Nicotine & Tobacco Research Volume 9, Number 2 (February 2007) 291–298
Now they have made it harder for nicotine to addict me, and even harder for THC to make me anxious and paranoid.
I'm even wise to the meth BS. Why would anyone take crappy street amphetamines when there are ADHD meds which are safer and less toxic when used as directed?
As well, if you seriously used nicotine, then you'd have an over-the-counter antidepressant in inhalant format called cigarettes. In low doses nicotine is a stimulant; in high doses, it is as effective as a first-generation anti-histamine in sedation and "calming the nerves".
The good news is, THC still is a sedative in low doses. The terrific news is, mirtazapine blocks the munchies because as an antihistamine, it's an effective sedative with munchies as side effect. :p
Of course, I'd never mix alcohol or hard drugs with my medication, because that's a waste of my effort to manage my disease, which is depression.
Since humor is a mature way of dealing with uncomfortable feelings of anxiety, fear and dread, I plan on dealing with depression with humor to counteract any negativity arising from those feelings.
In this way I have overcome my initial fear of medication by choosing which of them I wish to take. I chose mirtazapine because of its safety profile for sedative action, and chose gabapentin of its safety in relieving pain and helping me to express myself.
However, this blog entry does not represent the full picture of depression. It only represents the protective effect of mirtazapine and gabapentin on my brain. They are more useful than cigarettes and marijuana, because of their safety profile. Yet I would be foolish to solely rely on them, for they are not magic bullets.
References:
Nicotine's psychological effects: http://en.wikipedia.org/wiki/Nicotine#Psychoactive_effects
Gabapentin and alcohol withdrawal syndrome: Am J Health-Syst Pharm—Vol 65 Jun 1, 2008
p. 1039
Comparison of Gabapentin and Phenobarbital for treatment of alcohol withdrawal: DOI: 10.1080/10550490500419110
Comparison of Gabapentin and bupropion SR for stopping smoking: Nicotine & Tobacco Research Volume 7, Number 5 (October 2005) 809–813
Gabapentin for stopping smoking: Nicotine & Tobacco Research Volume 9, Number 2 (February 2007) 291–298
20101219
Update on my Meds
Today I am on my last of 7.5 mg (half of 15 mg tablet) of mirtazapine.
Fifty tablets of mirtazapine are stored with a package of 25 caplets of diphenhydramine in my drawer to be used as sedatives for insomnia only.
Thursday I got a new prescription for gabapentin, which helped bring out the best of me. My meds came from my primary GP, but in retrospect, it would have been less of a hassle to get it from my secondary GP, except that I couldn't get up at 7.30AM to get in to see him.
I got a good result from 200 mg Thursday night, and there was little sedation. The next morning, I took 7.5 mg of mirtazapine and the histamine-related sedation left me with impaired balance and related effects which took me 2 hours to adapt — the gabapentin helped because I took a 100 mg dose about an hour after the sedation hit me.
This morning, gabapentin has sparked a remarkable difference in me. I actually felt friendly and outgoing, and it appears to have reduced the usual shyness I used to have.
Yet much of my behavioral negativities actually has very little to do with the medication, but with being able to try something different.
Although I'd like natural health-food remedies and the like, psychopharmaceuticals are the emergency backup plan. With cognitive behavior therapy, they have worked in my case.
If insanity can be defined as doing the same thing over and over expecting a different outcome every time, then sanity is the ability to do something different.
Here is how I am going to do something different: I am open to responses from the anti-psychiatry crowd. Also, will the people who have tried gabapentin please respond?
Any responses demonizing medication will be ignored; such fear-mongering is based on emotional reasoning, which could lead to cognitive distortions.
If any thought pops in your head before you write, then please reread what I wrote and think through your feelings before responding. I'll try to do my best to think, think and think in kind! :)
Update for 20130116: I'm now on cyclobenzaprine 10 g and gabapentin 200 mg at bedtime.
Fifty tablets of mirtazapine are stored with a package of 25 caplets of diphenhydramine in my drawer to be used as sedatives for insomnia only.
Thursday I got a new prescription for gabapentin, which helped bring out the best of me. My meds came from my primary GP, but in retrospect, it would have been less of a hassle to get it from my secondary GP, except that I couldn't get up at 7.30AM to get in to see him.
I got a good result from 200 mg Thursday night, and there was little sedation. The next morning, I took 7.5 mg of mirtazapine and the histamine-related sedation left me with impaired balance and related effects which took me 2 hours to adapt — the gabapentin helped because I took a 100 mg dose about an hour after the sedation hit me.
This morning, gabapentin has sparked a remarkable difference in me. I actually felt friendly and outgoing, and it appears to have reduced the usual shyness I used to have.
Yet much of my behavioral negativities actually has very little to do with the medication, but with being able to try something different.
Although I'd like natural health-food remedies and the like, psychopharmaceuticals are the emergency backup plan. With cognitive behavior therapy, they have worked in my case.
If insanity can be defined as doing the same thing over and over expecting a different outcome every time, then sanity is the ability to do something different.
Here is how I am going to do something different: I am open to responses from the anti-psychiatry crowd. Also, will the people who have tried gabapentin please respond?
Any responses demonizing medication will be ignored; such fear-mongering is based on emotional reasoning, which could lead to cognitive distortions.
If any thought pops in your head before you write, then please reread what I wrote and think through your feelings before responding. I'll try to do my best to think, think and think in kind! :)
Update for 20130116: I'm now on cyclobenzaprine 10 g and gabapentin 200 mg at bedtime.
20101218
Rethinking My Meds
After reading Doctor Daniel G. Amen's book Change Your Brain, Change Your Life, I learned that gabapentin would improve temporal lobe function and control any possible seizures and aggression, as well as maintain emotional stability, relieve headaches, treat depression, and bipolar disorder.
Like mirtazapine, gabapentin has a good safety profile. While the former drug acts as a major sedative without the risk of benzodiazepine addiction, gabapentin has only moderate potential for the human body to develop a tolerance to it.
Indeed, this new psycho-pharmaceutical drug increases my ability to improve my mood by keeping it stable and thus improves my mental health.
After I chose mirtazapine because of its safety profile, I later was able to receive a prescription for gabapentin from my doctor after stating to him that I needed to manage pain and emotional stability.
After adding gabapentin to my medication regime of mirtazapine I've notice a change in my behavior and productivity.
To give you an idea of productivity, I'll list some things I got done in a day:
References:
Wikipedia on Daniel G. Amen: http://en.wikipedia.org/wiki/Daniel_G._Amen
Meet Doctor Amen: http://www.amenclinics.com/meet-dr-amen/ - Doctor Amen has a chain of clinics which use SPECT brain scans to get see in real-time the brain in action.
For people who are leery of having radio-nucleotides (radioactive markers used by medical specialists for making medical diagnoses) put in their blood stream, the Quackwatch website will confirm their fears: http://www.quackwatch.com/06ResearchProjects/amen.html
See also http://www.quackwatch.com/06ResearchProjects/amen_response.html
Disclaimer: the decision to ask for a month's supply of gabapentin was not originally due to reading Doctor Amen's book. In fact, I had been researching and studying many of the medications listed in the Appendix of his book on pages 307-313 (paperback edition) since 2006. Gabapentin showed up several times as having a high safety profile like mirtazapine.
Like mirtazapine, gabapentin has a good safety profile. While the former drug acts as a major sedative without the risk of benzodiazepine addiction, gabapentin has only moderate potential for the human body to develop a tolerance to it.
Indeed, this new psycho-pharmaceutical drug increases my ability to improve my mood by keeping it stable and thus improves my mental health.
After I chose mirtazapine because of its safety profile, I later was able to receive a prescription for gabapentin from my doctor after stating to him that I needed to manage pain and emotional stability.
After adding gabapentin to my medication regime of mirtazapine I've notice a change in my behavior and productivity.
To give you an idea of productivity, I'll list some things I got done in a day:
- created four videos to upload to Youtube.
- uploaded a couple pictures to Flickr and Picasa.
- created 3 songs for my new music album at Mix.DJ.
References:
Wikipedia on Daniel G. Amen: http://en.wikipedia.org/wiki/Daniel_G._Amen
Meet Doctor Amen: http://www.amenclinics.com/meet-dr-amen/ - Doctor Amen has a chain of clinics which use SPECT brain scans to get see in real-time the brain in action.
For people who are leery of having radio-nucleotides (radioactive markers used by medical specialists for making medical diagnoses) put in their blood stream, the Quackwatch website will confirm their fears: http://www.quackwatch.com/06ResearchProjects/amen.html
See also http://www.quackwatch.com/06ResearchProjects/amen_response.html
Disclaimer: the decision to ask for a month's supply of gabapentin was not originally due to reading Doctor Amen's book. In fact, I had been researching and studying many of the medications listed in the Appendix of his book on pages 307-313 (paperback edition) since 2006. Gabapentin showed up several times as having a high safety profile like mirtazapine.
20101205
HERV-W Linked to Bipolar Disorder, Multiple Sclerosis and Schizophrenia; XMRV Retrovirus & CFS
According to the following link, bipolar depression, MS and schizophrenia may be due to human endogenous retrovirus (HERV-W). A compromised immune system affects monocytes (white blood cells) which activate the HERV-W virus.
As well, the XMRV has been associated with chronic fatigue syndrome and prostate cancer.
This leads me to speculate the following, which might be validated by medical evidence:
IMHO this may explain how mirtazapine works: its anti-histamine action affects the histamine part of inflammation. Inflammation results when mast cells are broken down by scavanger white blood cells, releasing histamine. How this may trigger HERV-W and XMRV is in part an immune reaction resulting from a complex combination of factors including stress and a viral infection, specifically from the herpes family.
Another side effect of antihistamines is sedation. Thus mirtazapine's antidepressant action may most likely be due to the thorough bed rest I get with daily dosage, which reduce my stress levels.
Originally posted: 11/13/2010 04:10:00 AM
Updated and edited: 12/05/2010 05:26:00 PM
For more information, see the following links:
http://en.wikipedia.org/wiki/Endogenous_retrovirus
http://bipolar-hotbrain.blogspot.com/2010/07/virus-herv-w-could-be-cause-of.html
The XMRV Retrovirus: http://www.youtube.com/watch?v=86OQJjLbHt0
As well, the XMRV has been associated with chronic fatigue syndrome and prostate cancer.
This leads me to speculate the following, which might be validated by medical evidence:
IMHO this may explain how mirtazapine works: its anti-histamine action affects the histamine part of inflammation. Inflammation results when mast cells are broken down by scavanger white blood cells, releasing histamine. How this may trigger HERV-W and XMRV is in part an immune reaction resulting from a complex combination of factors including stress and a viral infection, specifically from the herpes family.
Another side effect of antihistamines is sedation. Thus mirtazapine's antidepressant action may most likely be due to the thorough bed rest I get with daily dosage, which reduce my stress levels.
Originally posted: 11/13/2010 04:10:00 AM
Updated and edited: 12/05/2010 05:26:00 PM
For more information, see the following links:
http://en.wikipedia.org/wiki/Endogenous_retrovirus
http://bipolar-hotbrain.blogspot.com/2010/07/virus-herv-w-could-be-cause-of.html
The XMRV Retrovirus: http://www.youtube.com/watch?v=86OQJjLbHt0
20101023
Is Mirtazapine Also a Pain Reliever?
It's been four months since starting mirtazapine, and I'm taking 30 mg a day.
Indeed mirtazapine is great for helping me sleep, yet one unexpected side effect is pain relief.
Yes, mirtazapine and mild exercise appears to reduce pain (headache and toothache). While I do not know the reason for the pain relief, it may be due to self-hypnosis - mirtazapine being a hypnotic - and improved metabolism of cortisol due to exercise.
Sedation is the usual effect of a hypnotic, and this drug isn't any different in that respect. However, being used to the sedative effects of mirtazapine, its hypnotic effect has help put to work the cognitive behavioral therapy that my therapist is patiently teaching me.
Also, this drug has helped me to learn from my mistakes.
Although it is possible I can easily learn from those mistakes on my own without medication, mirtazapine provides the calmness and reduced anxiety needed to function more fully both at home and in public.
IMHO each and every challenge while on mirtazapine makes it a "wonder drug" for me.
Indeed mirtazapine is great for helping me sleep, yet one unexpected side effect is pain relief.
Yes, mirtazapine and mild exercise appears to reduce pain (headache and toothache). While I do not know the reason for the pain relief, it may be due to self-hypnosis - mirtazapine being a hypnotic - and improved metabolism of cortisol due to exercise.
Sedation is the usual effect of a hypnotic, and this drug isn't any different in that respect. However, being used to the sedative effects of mirtazapine, its hypnotic effect has help put to work the cognitive behavioral therapy that my therapist is patiently teaching me.
Also, this drug has helped me to learn from my mistakes.
Although it is possible I can easily learn from those mistakes on my own without medication, mirtazapine provides the calmness and reduced anxiety needed to function more fully both at home and in public.
IMHO each and every challenge while on mirtazapine makes it a "wonder drug" for me.
20100808
My Rant on the Stresses of Daily Life and its Cure
You're sitting in gridlock during rush hour that you indirectly participate in creating by being overly productive beyond sustainability.
Later on the stress leads to autoimmune disorders, and many of us just ask for pills for our ills, which cascades into mental illness, depression, CV disease, diabetes etc.
And what do we do on weekends? Rather than living sober, we might even drink and/or drug recreationally.
All that living on the edge just makes the cells poop out. So, is the well examined life still the good life?
IDK, but the #1 improvement to one's health is to walk 5 miles 4 days of the week.
That's 0.8 miles or 8 city blocks a day. So the optimal for most people is to live that far from work, and be a walking commuter.
FWIW I don't drink or use drugs recreationally. Instead, I use one and only one drug medically as a sleep aid: mirtazapine.
Right now, I meditate a lot and, my goal is to get at least a few miles of walking done.
Later on the stress leads to autoimmune disorders, and many of us just ask for pills for our ills, which cascades into mental illness, depression, CV disease, diabetes etc.
And what do we do on weekends? Rather than living sober, we might even drink and/or drug recreationally.
All that living on the edge just makes the cells poop out. So, is the well examined life still the good life?
IDK, but the #1 improvement to one's health is to walk 5 miles 4 days of the week.
That's 0.8 miles or 8 city blocks a day. So the optimal for most people is to live that far from work, and be a walking commuter.
FWIW I don't drink or use drugs recreationally. Instead, I use one and only one drug medically as a sleep aid: mirtazapine.
Right now, I meditate a lot and, my goal is to get at least a few miles of walking done.
20100625
Client-Centred Therapy and Depression
In my case, I am certain that client-centred therapy plays a role in my recovery from depression, along with cues from the season.
Once I went to my first interview with the psychiatrist (shrink), I gave the 18 yr old diagnosis of borderline personality disorder whilst trying to present most of the sequelae of it.
In response I got the medication (meds) I wanted: mirtazapine.
After that, I decided to stabilize while recovering from shingles, which arose due to stress probably not related to mirtazapine.
After doing research on mirtazapine, the shrink realized with my help that I would be better letting my GP handle my meds after talking with the psychologist.
Currently, therapy is going well, and so's my life.
Yet the main reason is probably because it's summertime, tho it is because I acted to resolve family issues especially social rejection.
Recovery from mental illness does require a lot of work on the client.
What is helpful is not the medication roulette; it's being able to choose the medication and the course of therapy.
This would not have been possible 18 years ago.
The reason why I waited until now was because I felt after my initial years of therapy in the early 1980's, that I wasn't ready for talk therapy and mirtazapine was introduced in 1996.
I do not regret not going in for therapy earlier.
My only wish is that Remeron be more closely examined to be a safer anti-depressant for people whose moods are stabilized and are willing to be compliant with psychotherapy i.e. the older adult patients exhibiting depression without psychoses.
YMMV
Once I went to my first interview with the psychiatrist (shrink), I gave the 18 yr old diagnosis of borderline personality disorder whilst trying to present most of the sequelae of it.
In response I got the medication (meds) I wanted: mirtazapine.
After that, I decided to stabilize while recovering from shingles, which arose due to stress probably not related to mirtazapine.
After doing research on mirtazapine, the shrink realized with my help that I would be better letting my GP handle my meds after talking with the psychologist.
Currently, therapy is going well, and so's my life.
Yet the main reason is probably because it's summertime, tho it is because I acted to resolve family issues especially social rejection.
Recovery from mental illness does require a lot of work on the client.
What is helpful is not the medication roulette; it's being able to choose the medication and the course of therapy.
This would not have been possible 18 years ago.
The reason why I waited until now was because I felt after my initial years of therapy in the early 1980's, that I wasn't ready for talk therapy and mirtazapine was introduced in 1996.
I do not regret not going in for therapy earlier.
My only wish is that Remeron be more closely examined to be a safer anti-depressant for people whose moods are stabilized and are willing to be compliant with psychotherapy i.e. the older adult patients exhibiting depression without psychoses.
YMMV
20100621
Canadian Pharmacare VS US Medicaid/Medicare
Most mentally ill people get intervened early, and because of mood instability are given drugs until they stabilize, usually lithium despite the medical risks.
IMHO the thinking of most psychiatrists is that Omega-3 in fish oils as supplementation takes too long (six weeks).
However, most meds lose their efficiency in 6 weeks due to the placebo effect.
Indeed, most meds work because of the placebo effect.
In short, it is the patient's belief in getting well which results in recovery.
However, in Canada, most patients eventually get status as person with disabilities under welfare. Depending on the severity of symptoms, this qualifies a patient for either Plan C (most medications are free even if you don't have PWD) or Plan G (all psychomeds are free as is the trip to the psych ward).
However, if a patient has relief of his anxiety handled by obsolete medication (antihistamines), he has to pay for the cost himself (including OTC antihistamines).
It looks like a lot of meds under American Medicaid/Medicare are not covered, or closer to the truth, most SSI recipients do not know which meds are covered.
I wouldn't agree to SSRIs because of them worsening anxiety and causing nausea, along with the risk of serotonin syndrome.
Relief of insomnia is foremost in preventing hypomania and its probable evolution into mania and psychoses. Therefore I look for a hypnotic effect in medication. It must have an antihistamine action. Next I look for safety and tolerance.
This is what led me to mirtazapine (Remeron), mainly because of those mentoined effects and the fact that in most meta-analyses of mirtazapine versus the SSRIs, TCAs and other antidepressants, mirtazapine exhibited a profile which is no better than placebo.
I've also researched gabapentin and realized that it would cause glaucoma or at the least, ruin my sight.
Yet at the six-week mark, 15 mg of mirtazapine no longer makes me sleepy. This makes me determined to continue my psychotherapy and see how well the drug has made me of mind.
If I am only using mirtazapine after its effects have plateaued, then I would have to consider the side effects of extended use of mirtazapine to decide if they outweigh its use as placebo.
2012-12-27: Today I stopped using mirtazapine a year ago. At the moment I use flexeril and gabapentin, which helps keep me sedated. The gabapentin in particular improves deep sleep better than benzodiazepines. Flexeril's sedation helps induce sleep.
These medications work for me, since I stopped believing in the DSM as a useful guide which involves arbitrary pigeon-holing of mental health consumers. The only use the DSM I feel is to manufacture mental illness.
However, I am anti-psychiatry. but believe in medication to deal with insomnia and mild aches and pain. Also, I am an advocate of vigourous physical exercise (brisk walking for more than one mile).
IMHO the thinking of most psychiatrists is that Omega-3 in fish oils as supplementation takes too long (six weeks).
However, most meds lose their efficiency in 6 weeks due to the placebo effect.
Indeed, most meds work because of the placebo effect.
In short, it is the patient's belief in getting well which results in recovery.
However, in Canada, most patients eventually get status as person with disabilities under welfare. Depending on the severity of symptoms, this qualifies a patient for either Plan C (most medications are free even if you don't have PWD) or Plan G (all psychomeds are free as is the trip to the psych ward).
However, if a patient has relief of his anxiety handled by obsolete medication (antihistamines), he has to pay for the cost himself (including OTC antihistamines).
It looks like a lot of meds under American Medicaid/Medicare are not covered, or closer to the truth, most SSI recipients do not know which meds are covered.
I wouldn't agree to SSRIs because of them worsening anxiety and causing nausea, along with the risk of serotonin syndrome.
Relief of insomnia is foremost in preventing hypomania and its probable evolution into mania and psychoses. Therefore I look for a hypnotic effect in medication. It must have an antihistamine action. Next I look for safety and tolerance.
This is what led me to mirtazapine (Remeron), mainly because of those mentoined effects and the fact that in most meta-analyses of mirtazapine versus the SSRIs, TCAs and other antidepressants, mirtazapine exhibited a profile which is no better than placebo.
I've also researched gabapentin and realized that it would cause glaucoma or at the least, ruin my sight.
Yet at the six-week mark, 15 mg of mirtazapine no longer makes me sleepy. This makes me determined to continue my psychotherapy and see how well the drug has made me of mind.
If I am only using mirtazapine after its effects have plateaued, then I would have to consider the side effects of extended use of mirtazapine to decide if they outweigh its use as placebo.
2012-12-27: Today I stopped using mirtazapine a year ago. At the moment I use flexeril and gabapentin, which helps keep me sedated. The gabapentin in particular improves deep sleep better than benzodiazepines. Flexeril's sedation helps induce sleep.
These medications work for me, since I stopped believing in the DSM as a useful guide which involves arbitrary pigeon-holing of mental health consumers. The only use the DSM I feel is to manufacture mental illness.
However, I am anti-psychiatry. but believe in medication to deal with insomnia and mild aches and pain. Also, I am an advocate of vigourous physical exercise (brisk walking for more than one mile).
20100619
Why I Chose Medication
Earlier in 2010, I chose to use mirtazapine, not to cure depression, but to augment psychotherapy, and to use direct experience to validate my hypothesis about the neurophysiological cause of the disorder (Borderline Personality Disorder) I was originally diagnosed with i.e. mild Traumatic Brain Injury (mTBI).
Psychotherapy lasted for a year.
My hypothesis is that the many mTBI I received from childhood into adulthood resulted in trauma which is the main cause of BPD. My use of mirtazapine is to treat the side effects of mTBI, of which depression is one of them.
I am also of the opinion that mirtazapine, as a strong sedative, also relieved me of the fear of heights, which demonstrates that phobias are in part a neurophysiological affect of mTBI in my case.
Originally posted: June 19, 2010 1847H
Update posted: March 4, 2013 1522H
Psychotherapy lasted for a year.
My hypothesis is that the many mTBI I received from childhood into adulthood resulted in trauma which is the main cause of BPD. My use of mirtazapine is to treat the side effects of mTBI, of which depression is one of them.
I am also of the opinion that mirtazapine, as a strong sedative, also relieved me of the fear of heights, which demonstrates that phobias are in part a neurophysiological affect of mTBI in my case.
Originally posted: June 19, 2010 1847H
Update posted: March 4, 2013 1522H
20100603
Why Psychosis Sucks: the Hidden Agenda for Early Detection
"When sleep deprivation becomes great enough, the effects mimic those of psychosis." -- Stanley Coren, Ph.D., "Sleep Deprivation, Psychosis and Mental Efficiency"
Early detection of psychosis in today's youth may indicate a hidden agenda by the State to manufacture mental health consumers amongst susceptible young adults aged 18-24.
Once this targeted group of consumer normalize mental illness and recover from sleep deprivation, they may do everything to avoid a relapse including moderating behavior leading to sleep deprivation via naps and mainly calling it a night earlier than they used to do.
Although any youth who is not compliant might be a walking time bomb, it is useful for mental health professionals to overlook use of the life-or-death scenario to facilitate compliance but to order a blood test to show the side effects of burning the candle at both ends.
IMHO the stress from short sleep periods will impact the body such that even a basic non-fasting blood test would reveal warning signs such as low white blood cell (WBC) counts and associated changes in the kinds of white blood cells.
My opinion is based on three blood tests done over the past decade. My recent blood test shows everything normal with no low WBC counts, while the test from two years shows low WBC and neutrophil counts and the test from circa 2004 shows at least four low counts.
I can affirm that my sleep pattern in 2008 was not the greatest (about 5-7 hours a night), and it was probably much worse in 2004 (4-6 hours), but it's been averaging 8-9 hours a night.
Also when I am tired from 1 to 3 PM, refraining from reading or doing any heavy physical acitivity usually tides me over until the fatigue passes.
Currently, with the Remeron regiment of 30 mg a day in 4 divided doses, I am in top mental condition compared to a month ago, 3 months ago and even 6 months ago.
Reference:
Stanley Coren, Ph.D., "Sleep Deprivation, Psychosis and Mental Efficiency" http://www.psychiatrictimes.com/display/article/10168/54471?pageNumber=2
Early detection of psychosis in today's youth may indicate a hidden agenda by the State to manufacture mental health consumers amongst susceptible young adults aged 18-24.
Once this targeted group of consumer normalize mental illness and recover from sleep deprivation, they may do everything to avoid a relapse including moderating behavior leading to sleep deprivation via naps and mainly calling it a night earlier than they used to do.
Although any youth who is not compliant might be a walking time bomb, it is useful for mental health professionals to overlook use of the life-or-death scenario to facilitate compliance but to order a blood test to show the side effects of burning the candle at both ends.
IMHO the stress from short sleep periods will impact the body such that even a basic non-fasting blood test would reveal warning signs such as low white blood cell (WBC) counts and associated changes in the kinds of white blood cells.
My opinion is based on three blood tests done over the past decade. My recent blood test shows everything normal with no low WBC counts, while the test from two years shows low WBC and neutrophil counts and the test from circa 2004 shows at least four low counts.
I can affirm that my sleep pattern in 2008 was not the greatest (about 5-7 hours a night), and it was probably much worse in 2004 (4-6 hours), but it's been averaging 8-9 hours a night.
Also when I am tired from 1 to 3 PM, refraining from reading or doing any heavy physical acitivity usually tides me over until the fatigue passes.
Currently, with the Remeron regiment of 30 mg a day in 4 divided doses, I am in top mental condition compared to a month ago, 3 months ago and even 6 months ago.
Reference:
Stanley Coren, Ph.D., "Sleep Deprivation, Psychosis and Mental Efficiency" http://www.psychiatrictimes.com/display/article/10168/54471?pageNumber=2
20100522
A Week and a Day With Mirtazapine
On May 11, 2010, I attended my appointment with Dr. "A", the pdoc (psychiatrist). Most of my behavior with him is consistent with borderline personality disorder: giving out details not related to self to related to family of origin, but being vague about my own complaints.
At the conclusion of my first interview with Dr. "A", he writes me a script for mirtazapine at 15 mg to be taken at 1-2 pills nightly for one month (60 pills). He then states that serotonin may cause nausea, and I get the impression would have similar effects to Selective Serotonin Re-uptake Inhibitor (SSRI) antidepressants.
When the pdoc came to medication, I selected mirtazapine because my initial on-line research gave it a good safety profile for the average North American, which I am not.
For I am a Japanese-Canadian person, 51 years old, and male. IMHO the cultural and genetic (ethnic) background of all the mirtazapine test groups probably did not include a lot of Asians, but it should because of the Asian sensitivity to psychopharmaceuticals (psychiatric medication or pmeds). (See Ethnicity and psychopharmacology APT(1999), vol.5,p.91; A Psychiatric Residency Curriculum About Asian-American Issues Academic Psychiatry 26:225-236, December 2002)
On the other hand, my pdoc is Anglo-Canadian, and landed immigrant from the UK. Schooled in Western psychiatry, he's been trained to overlook my ethnic background and treat only my brain. Yet his faith in the "magic" of psychiatric medication had led him to assume my brain, physiologically, is like any other brain.
However, the following week only proves to me that my brain and my body is not made to take pmeds at the recommended doses.
In the following journal entries, I've redacted MHC professionals names to letters of the alphabet to protect their privacy. As well, when I need to comment on a journal entry, the commentary is quite obvious.
According to BC provincial health protocol for mental health, a mental health consumer (me) is assigned a case worker with a Bachelor's of Social Work at the local office, a pdoc to figure out which medication is prescribed, and a pyschotherapist with the expertise and qualification to handle the particular issue (integration of person of color into Western culture with focus on family of origin).
Even though there may be opinionated statements in this article, in no way do they reflect upon the professionals in a negative light. Any reader naïve to my style of hyperbole and its multifaceted confabulation should take a lot of salt to what they are about to digest...
SHK 20100522.0605
---
Tuesday, May 11, 9:08 PM
I read up on Mirtazapine, and according to what I've read, it does not cause nausea. In fact, it relieves nausea. The antihistamine effect is stronger than hydroxyzine, though.
Reference: http://en.wikipedia.org/wiki/Mirtazapine
Tuesday, May 11, 9:40 PM
At 9:30 PM, I've taken the first mirtazapine dose (15 mg). Within the past ten minutes, I felt "better", which may be due to the antihistamine effect.
Also, the pain from a cold sore on my upper lip and earache in the right ear have faded somewhat. This may be due to moderate peripheral α1 adrenergic antagonism. [Commentary: It's actually due to the antihistamine effect.]
Tuesday, May 11, 9:51 PM: Hopefully the hypotension will be manageable. I just feel relaxed because of the antihistamine's effect. None of the nausea appeared at all, which proves that it is not a side effect.
Tuesday, May 11, 10:05 PM
The mellowness is a plus, though I have moderate difficulty in forming my thoughts.
Yet there is no real anxiety about this. I really like this effect, but feel that it's preventing me from freely expressing myself in the journal.
Currently, I just want to meditate while on mirtazapine. The more I focus on concentrating, the less I want to use that concentration to write.
There is very little anxiety, and if there is anxiety, then I do not feel it impeding my thoughts.
Tuesday, May 11, 10:17 PM
I ate a donut, and had a multivitamin. The mirtazapine's effects are still happening: calmness, mellowness, a sense of joy, serendipity, serenity... these words barely describe the feeling.
Yet not a tinge of nausea is present.
Tuesday, May 11, 10:36 PM
Oh, yes! I finished a bottle of water without thinking, thanks to mirtazapine.
[Commentary: Within an hour, I've turned off my computer because the sedative effect of 15 mg of mirtazapine has overtaken me.]
Wednesday, May 12, 12:21 PM
This morning I got up at around 10 AM. I spent the morning writing, but wrote only briefly about Buddha Nature. It seemed easily to read than it did to write. Though I am not surprised by the mood swing side effect, IMHO it should be easier to control because of experience with my changes in mood.
[Commentary: "mood swing side effect" refers to agitation, restlessness, irritability, aggression. On waking up at around 9 AM, I felt malaise or lassitude. After shaking off this feeling, I wrote in my Spiritual Journal about Buddha Nature, which will be added to my Buddhist notes as Buddhahood.]
Thursday, May 13, 9:52 AM
The mirtazapine appears to have worsened the cold sore and mouth cankers I had on the day I filled my prescription. I have fever blisters on my upper lip, and my mouth has been dry on waking.
I am getting mouth and skin rash/lesions because of side effect of Mirtazapine.
http://doublecheckmd.com/EffectsDetail.do?dname=mirtazapine&sid=13590&eid=6621#selist
I also have enlarged lymph nodes as a result of infection.
The 30 mg dose also makes me feel more aggressive, angry, hostile, and mean. Though, I'm sure that what it actually does is moderate impulse control negatively.
Friday, May 14, 9:11 AM
Today I called the MHC (Mental Health Centre) and reported the symptoms I've been experiencing, which now includes fever and swollen upper lip.
The medication causing these symptoms is mirtazapine. Tuesday evening, I took 15 mg at bedtime; and Wednesday evening, 30 mg.
After experiencing the physical symptoms, the use of mirtazapine was discontinued Thursday, but the only medication used Thursday evening was one 10 mg dose of hydroxyzine to act as a sedative.
So the physical symptoms are fever, sore throat, mouth ulcers, skin lesions, and fever blisters.
The psychological symptoms are: depression, aggression, agitation. There also is a negative self image due to skin lesions on the face.
Friday, May 14, 10:46 AM
Dr. "A" called back, and I gave him the list of symptoms I had. He confirmed that I had discontinued mirtazapine as of Thursday. While he stated that hydroxyzine may be too expensive for me to use, and that he may be recommending other medication, since I have 8 capsules left, IF the swollen upper lip and face becomes a problem, then I will take hydroxyzine tonight at bedtime.
[Commentary: the pdoc also claimed that mirtazapine usually never has that effect. This is true, but it did contribute to a change in body chemistry which IMHO lowered my WBC rapidly enough for the zoster virus to activate as shingles. It also indirectly worsened my psychoneurotic behaviorisms I exhibit when not able to express myself by either read, writing, and writing in my journal on the computer.]
Friday, May 14, 2:23 PM
Since I am able to tolerate the pain, I want to tough out the symptoms. The reason is, I am not in very much discomfort. This is why when the roommate expressed her concern, I wasn't willing to agree that it needs a doctor to be looked after properly.
IMHO, swollen lymph nodes mean that my body is fighting off the infection. Fever means that the infection is bad, but not life threatening.
However, before deciding to act, the symptoms need to be much worse than this.
[Commentary: Between 3:00 PM and 6:00 PM I visit Emergency Ward at the local hospital.]
Friday, May 14, 6:03 PM
It turns out that the mirtazapine may have reactivated the herpes zoster virus (chicken pox) as shingles.
http://en.wikipedia.org/wiki/Herpes_zoster
After getting my condition diagnosed at the hospital, the emergency doctor gave me a prescription for acyclovir, a potent antiviral drug, which is to be taken 5 x daily for 7 days.
So I have to take 5 times daily Acyclovir for a week, religiously, and preferably with food, from May 14 until May 20.
Friday, May 14, 6:14 PM
The lesions and fever blisters are due to herpes simplex zoster (originally chicken pox), which reactivated as shingles. Most likely, mirtazapine played an indirect part in reactivating it.
IMHO influenza may have reactivated the herpes virus, and both hydroxyzine and mirtazapine may have been the most recent trigger, due to their effect on the immune system via histamine suppression.
When I took my first dose, Mirtazapine had a strong histamine rebound effect on me.
Friday, May 14, 7:46 PM
On Monday (May 16) I intend to call Dr. "A" to update him about the symptoms I previously attributed to mirtazapine.
It turns out that the dormant herpes zoster virus reactivated, IMHO due to a combination of stress, including the use of hydroxyzine & recently mirtazapine.
After getting my condition diagnosed at the hospital, the emergency doctor gave me a prescription for acyclovir, a potent antiviral drug, which is to be taken 5 x daily for 7 days.
[Commentary: when I compare the name of my pdoc in this entry with the previous entry on Fri, May 14, 10:46 AM, his name has changed in this entry. Nine hours have passed by this point.]
Saturday, May 15, 11:40 PM
One side effect of recovery from mirtazapine I noticed was mild hallucinations where I see a comic book. [Commentary: though this can be attributed to having finished inventory on the last 30 comics in my collection. These hallucinations only occur when I am tired, IMHO as a reminder from my subconscious to take a break from whatever I am doing at the moment and rest. I also have a dream later on that night, though 72 hours later, no recall of details of that dream remain, due to it being trivial in nature.]
Sunday, May 16, 1:54 PM
The right side of my face is slightly swollen. There are two lesions under the eye near the nose, two across the cheek, three on the right side of the nose, and one large one at the top of the middle of the upper lip. They all follow a serpentine pattern from eye to upper lip. This is the symptom of shingles.
http://en.wikipedia.org/wiki/Dermatomic_area
Monday, May 17, 10:58 AM
At 10:41 AM I called up the MHC, and got Dr. "A" surname wrong. After the initial confusion experienced with the receptionist, I left a message for my caseworker, "B", mentioned the herpes (shingles), being medicated for it, being on hydroxyzine, and asking if I could return to mirtazapine at 7.5 mg on May 23 after the hydroxyzine runs out.
Monday, May 17, 6:08 PM
Quite possibly the activation of shingles (herpes zoster) was precipitated by a rapid onset of neutropenia.
This is similar to the case study online:
http://psy.psychiatryonline.org/cgi/content/full/50/3/299?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=mirtazapine&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
Tuesday, May 18, 8:32 AM
I just thought of something: improvement of my neutrophil count, to lower the risk of mirtazapine causing a bad reaction.
For now, it's in my best interest to get a baseline blood test done.
[Commentary: this entry is important to explain the next entry.
Eating a lot more than I usually do when not ill should improve the neutrophil count, as well as taking the antiviral medication.]
Tuesday, May 18, 6:50 PM
After updating "B" Monday through voice-mail, there's been no response from Dr. "A" regarding returning to Mirtazapine. Also, my research on-line about mirtazapine indicates that returning to the drug may reduce my ANC (absolute neutrophil count) and WBC (white blood count). The symptoms of being on Mirtazapine from May 11 to 12, were similar to hypomania. [Commentary: IMHO it seems similar to cyclothymia. However, when I've been isolated on the computer for more than 4 hours, I may become mute and may show irritability to interruption of my current activity. This is probably one of the symptoms of the borderline personality disorder.]
From Friday May 14 until Sunday May 16 it felt more like a return to depression, but I attribute that feeling to change in self-image due to the temporary disfigurement shingles causes when it affects the face.
Self-care has been reduced, and every second or third day I spend too much time behind the computer, in an attempt to avoid facing with the reality effectively.
[Commentary: Actually, being on the computer almost continuously for almost 10 hours had led to a deterioration of mood and behavior around 6:30 PM.]
Recommendations:
From pdoc, ask for SCID-DSMIV diagnosis.
Request starting dose of mirtazapine at 3.75 mg indefinitely.
From GP, ask for blood test to get baseline.
Friday, May 21, 9:38 PM
Update: so I called the MHC, inform the receptionist of what I've learned about mirtazapine, and the shingles which results from its use. 15 minutes later the psychologist calls back to tell me to discuss it with my GP.
After talking to my GP, he told me that he can't approve of any reduction in dosage for mirtazapine, and that the pdoc will have to try another medication. At this point, I replied "I really rather stick with mirtazapine at the lowest dose ( less than 3.75 mg) possible than try an SSRI!"
Why? Because the pdoc made it seem like he'll be playing SSRI roulette until we find the correct dose, or even better, stuck on Seroquel or olanzapine because of a calculated risk with an SSRI.
Regarding Remeron, I've read its monograph from Health Canada, and it states that mirtazapine has antidepressant activity at 0.5 and 1.0 mg.
So, obviously, going from 15 to 30 mg over 48 hours precipitated the shingles (varicella zoster virus aka VZV ) reaction to rapid changes in my WBC.
Had I wisely titrated from 3.75 mg over a week, I wouldn't have gone through a week of pain to endure a few days of depressive psychosis ("I feel too self-conscious with this painful, blistering skin rash - and the painful neuralgia!"), only to recover a few days later, and make my psychologist's first interview.
Saturday, May 22, 5:02 AM
Addendum: If my math skills are up to snuff, it appears that mirtazapine's clinical trials have given enough statistics to help me calculate the number needed to cause harm.
That number is 17, but the odds are 1.25-1.75 to 1 that you'd get any one of the side effects. With paxil, the number needed to harm is 50, but the odds are like 2 to 1 i.e. you are twice a likely to get any side effect than you would with placebo.
Therefore, mirtazapine evens the odds ever so slightly. The only benefits in exchange for risk of lowering WBC that is appealing is its ability to tolerate nausea, and the lack of serotonin withdrawal symptoms which the SSRI and SNRI medications have in spades.
So I am going to build tolerance to mirtazapine by titrating using the hydration method i.e. dissolve 3.75 mg of the drug in about 250 ml water, let it sit for a few hours, and then sip it slowly.
Since that much water takes about 4-5 sips, I could titrate the drug over 4 hours, rather than ingest one half dose at bedtime. The only risk here is that of waking dreams, which the literature calls "hallucinations".
---
References:
Ethnopsychopharmacology: http://en.wikipedia.org/wiki/Ethnopsychopharmacology
Varicella Zoster virus: http://en.wikipedia.org/wiki/Varicella_zoster_virus
Zoster reactivation worst case: http://www.hivinsite.org/InSite?page=kb-05-03-01
Statistics involving pharmacology:
Number needed to harm: http://en.wikipedia.org/wiki/Number_needed_to_harm
Health Canada Database for Drugs:
http://www.hc-sc.gc.ca/dhp-mps/prodpharma/databasdon/index-eng.php
Both hydroxyzine and mirtazapine have lots of pages about their pharmacology and toxicology. The Health Canada website should have the main monograph to make the probability statistics.
At the conclusion of my first interview with Dr. "A", he writes me a script for mirtazapine at 15 mg to be taken at 1-2 pills nightly for one month (60 pills). He then states that serotonin may cause nausea, and I get the impression would have similar effects to Selective Serotonin Re-uptake Inhibitor (SSRI) antidepressants.
When the pdoc came to medication, I selected mirtazapine because my initial on-line research gave it a good safety profile for the average North American, which I am not.
For I am a Japanese-Canadian person, 51 years old, and male. IMHO the cultural and genetic (ethnic) background of all the mirtazapine test groups probably did not include a lot of Asians, but it should because of the Asian sensitivity to psychopharmaceuticals (psychiatric medication or pmeds). (See Ethnicity and psychopharmacology APT(1999), vol.5,p.91; A Psychiatric Residency Curriculum About Asian-American Issues Academic Psychiatry 26:225-236, December 2002)
On the other hand, my pdoc is Anglo-Canadian, and landed immigrant from the UK. Schooled in Western psychiatry, he's been trained to overlook my ethnic background and treat only my brain. Yet his faith in the "magic" of psychiatric medication had led him to assume my brain, physiologically, is like any other brain.
However, the following week only proves to me that my brain and my body is not made to take pmeds at the recommended doses.
In the following journal entries, I've redacted MHC professionals names to letters of the alphabet to protect their privacy. As well, when I need to comment on a journal entry, the commentary is quite obvious.
According to BC provincial health protocol for mental health, a mental health consumer (me) is assigned a case worker with a Bachelor's of Social Work at the local office, a pdoc to figure out which medication is prescribed, and a pyschotherapist with the expertise and qualification to handle the particular issue (integration of person of color into Western culture with focus on family of origin).
Even though there may be opinionated statements in this article, in no way do they reflect upon the professionals in a negative light. Any reader naïve to my style of hyperbole and its multifaceted confabulation should take a lot of salt to what they are about to digest...
SHK 20100522.0605
---
Tuesday, May 11, 9:08 PM
I read up on Mirtazapine, and according to what I've read, it does not cause nausea. In fact, it relieves nausea. The antihistamine effect is stronger than hydroxyzine, though.
Reference: http://en.wikipedia.org/wiki/Mirtazapine
Tuesday, May 11, 9:40 PM
At 9:30 PM, I've taken the first mirtazapine dose (15 mg). Within the past ten minutes, I felt "better", which may be due to the antihistamine effect.
Also, the pain from a cold sore on my upper lip and earache in the right ear have faded somewhat. This may be due to moderate peripheral α1 adrenergic antagonism. [Commentary: It's actually due to the antihistamine effect.]
Tuesday, May 11, 9:51 PM: Hopefully the hypotension will be manageable. I just feel relaxed because of the antihistamine's effect. None of the nausea appeared at all, which proves that it is not a side effect.
Tuesday, May 11, 10:05 PM
The mellowness is a plus, though I have moderate difficulty in forming my thoughts.
Yet there is no real anxiety about this. I really like this effect, but feel that it's preventing me from freely expressing myself in the journal.
Currently, I just want to meditate while on mirtazapine. The more I focus on concentrating, the less I want to use that concentration to write.
There is very little anxiety, and if there is anxiety, then I do not feel it impeding my thoughts.
Tuesday, May 11, 10:17 PM
I ate a donut, and had a multivitamin. The mirtazapine's effects are still happening: calmness, mellowness, a sense of joy, serendipity, serenity... these words barely describe the feeling.
Yet not a tinge of nausea is present.
Tuesday, May 11, 10:36 PM
Oh, yes! I finished a bottle of water without thinking, thanks to mirtazapine.
[Commentary: Within an hour, I've turned off my computer because the sedative effect of 15 mg of mirtazapine has overtaken me.]
Wednesday, May 12, 12:21 PM
This morning I got up at around 10 AM. I spent the morning writing, but wrote only briefly about Buddha Nature. It seemed easily to read than it did to write. Though I am not surprised by the mood swing side effect, IMHO it should be easier to control because of experience with my changes in mood.
[Commentary: "mood swing side effect" refers to agitation, restlessness, irritability, aggression. On waking up at around 9 AM, I felt malaise or lassitude. After shaking off this feeling, I wrote in my Spiritual Journal about Buddha Nature, which will be added to my Buddhist notes as Buddhahood.]
Thursday, May 13, 9:52 AM
The mirtazapine appears to have worsened the cold sore and mouth cankers I had on the day I filled my prescription. I have fever blisters on my upper lip, and my mouth has been dry on waking.
I am getting mouth and skin rash/lesions because of side effect of Mirtazapine.
http://doublecheckmd.com/EffectsDetail.do?dname=mirtazapine&sid=13590&eid=6621#selist
I also have enlarged lymph nodes as a result of infection.
The 30 mg dose also makes me feel more aggressive, angry, hostile, and mean. Though, I'm sure that what it actually does is moderate impulse control negatively.
Friday, May 14, 9:11 AM
Today I called the MHC (Mental Health Centre) and reported the symptoms I've been experiencing, which now includes fever and swollen upper lip.
The medication causing these symptoms is mirtazapine. Tuesday evening, I took 15 mg at bedtime; and Wednesday evening, 30 mg.
After experiencing the physical symptoms, the use of mirtazapine was discontinued Thursday, but the only medication used Thursday evening was one 10 mg dose of hydroxyzine to act as a sedative.
So the physical symptoms are fever, sore throat, mouth ulcers, skin lesions, and fever blisters.
The psychological symptoms are: depression, aggression, agitation. There also is a negative self image due to skin lesions on the face.
Friday, May 14, 10:46 AM
Dr. "A" called back, and I gave him the list of symptoms I had. He confirmed that I had discontinued mirtazapine as of Thursday. While he stated that hydroxyzine may be too expensive for me to use, and that he may be recommending other medication, since I have 8 capsules left, IF the swollen upper lip and face becomes a problem, then I will take hydroxyzine tonight at bedtime.
[Commentary: the pdoc also claimed that mirtazapine usually never has that effect. This is true, but it did contribute to a change in body chemistry which IMHO lowered my WBC rapidly enough for the zoster virus to activate as shingles. It also indirectly worsened my psychoneurotic behaviorisms I exhibit when not able to express myself by either read, writing, and writing in my journal on the computer.]
Friday, May 14, 2:23 PM
Since I am able to tolerate the pain, I want to tough out the symptoms. The reason is, I am not in very much discomfort. This is why when the roommate expressed her concern, I wasn't willing to agree that it needs a doctor to be looked after properly.
IMHO, swollen lymph nodes mean that my body is fighting off the infection. Fever means that the infection is bad, but not life threatening.
However, before deciding to act, the symptoms need to be much worse than this.
[Commentary: Between 3:00 PM and 6:00 PM I visit Emergency Ward at the local hospital.]
Friday, May 14, 6:03 PM
It turns out that the mirtazapine may have reactivated the herpes zoster virus (chicken pox) as shingles.
http://en.wikipedia.org/wiki/Herpes_zoster
After getting my condition diagnosed at the hospital, the emergency doctor gave me a prescription for acyclovir, a potent antiviral drug, which is to be taken 5 x daily for 7 days.
So I have to take 5 times daily Acyclovir for a week, religiously, and preferably with food, from May 14 until May 20.
Friday, May 14, 6:14 PM
The lesions and fever blisters are due to herpes simplex zoster (originally chicken pox), which reactivated as shingles. Most likely, mirtazapine played an indirect part in reactivating it.
IMHO influenza may have reactivated the herpes virus, and both hydroxyzine and mirtazapine may have been the most recent trigger, due to their effect on the immune system via histamine suppression.
When I took my first dose, Mirtazapine had a strong histamine rebound effect on me.
Friday, May 14, 7:46 PM
On Monday (May 16) I intend to call Dr. "A" to update him about the symptoms I previously attributed to mirtazapine.
It turns out that the dormant herpes zoster virus reactivated, IMHO due to a combination of stress, including the use of hydroxyzine & recently mirtazapine.
After getting my condition diagnosed at the hospital, the emergency doctor gave me a prescription for acyclovir, a potent antiviral drug, which is to be taken 5 x daily for 7 days.
[Commentary: when I compare the name of my pdoc in this entry with the previous entry on Fri, May 14, 10:46 AM, his name has changed in this entry. Nine hours have passed by this point.]
Saturday, May 15, 11:40 PM
One side effect of recovery from mirtazapine I noticed was mild hallucinations where I see a comic book. [Commentary: though this can be attributed to having finished inventory on the last 30 comics in my collection. These hallucinations only occur when I am tired, IMHO as a reminder from my subconscious to take a break from whatever I am doing at the moment and rest. I also have a dream later on that night, though 72 hours later, no recall of details of that dream remain, due to it being trivial in nature.]
Sunday, May 16, 1:54 PM
The right side of my face is slightly swollen. There are two lesions under the eye near the nose, two across the cheek, three on the right side of the nose, and one large one at the top of the middle of the upper lip. They all follow a serpentine pattern from eye to upper lip. This is the symptom of shingles.
http://en.wikipedia.org/wiki/Dermatomic_area
Monday, May 17, 10:58 AM
At 10:41 AM I called up the MHC, and got Dr. "A" surname wrong. After the initial confusion experienced with the receptionist, I left a message for my caseworker, "B", mentioned the herpes (shingles), being medicated for it, being on hydroxyzine, and asking if I could return to mirtazapine at 7.5 mg on May 23 after the hydroxyzine runs out.
Monday, May 17, 6:08 PM
Quite possibly the activation of shingles (herpes zoster) was precipitated by a rapid onset of neutropenia.
This is similar to the case study online:
http://psy.psychiatryonline.org/cgi/content/full/50/3/299?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=mirtazapine&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
Tuesday, May 18, 8:32 AM
I just thought of something: improvement of my neutrophil count, to lower the risk of mirtazapine causing a bad reaction.
For now, it's in my best interest to get a baseline blood test done.
[Commentary: this entry is important to explain the next entry.
Eating a lot more than I usually do when not ill should improve the neutrophil count, as well as taking the antiviral medication.]
Tuesday, May 18, 6:50 PM
After updating "B" Monday through voice-mail, there's been no response from Dr. "A" regarding returning to Mirtazapine. Also, my research on-line about mirtazapine indicates that returning to the drug may reduce my ANC (absolute neutrophil count) and WBC (white blood count). The symptoms of being on Mirtazapine from May 11 to 12, were similar to hypomania. [Commentary: IMHO it seems similar to cyclothymia. However, when I've been isolated on the computer for more than 4 hours, I may become mute and may show irritability to interruption of my current activity. This is probably one of the symptoms of the borderline personality disorder.]
From Friday May 14 until Sunday May 16 it felt more like a return to depression, but I attribute that feeling to change in self-image due to the temporary disfigurement shingles causes when it affects the face.
Self-care has been reduced, and every second or third day I spend too much time behind the computer, in an attempt to avoid facing with the reality effectively.
[Commentary: Actually, being on the computer almost continuously for almost 10 hours had led to a deterioration of mood and behavior around 6:30 PM.]
Recommendations:
From pdoc, ask for SCID-DSMIV diagnosis.
Request starting dose of mirtazapine at 3.75 mg indefinitely.
From GP, ask for blood test to get baseline.
Friday, May 21, 9:38 PM
Update: so I called the MHC, inform the receptionist of what I've learned about mirtazapine, and the shingles which results from its use. 15 minutes later the psychologist calls back to tell me to discuss it with my GP.
After talking to my GP, he told me that he can't approve of any reduction in dosage for mirtazapine, and that the pdoc will have to try another medication. At this point, I replied "I really rather stick with mirtazapine at the lowest dose ( less than 3.75 mg) possible than try an SSRI!"
Why? Because the pdoc made it seem like he'll be playing SSRI roulette until we find the correct dose, or even better, stuck on Seroquel or olanzapine because of a calculated risk with an SSRI.
Regarding Remeron, I've read its monograph from Health Canada, and it states that mirtazapine has antidepressant activity at 0.5 and 1.0 mg.
So, obviously, going from 15 to 30 mg over 48 hours precipitated the shingles (varicella zoster virus aka VZV ) reaction to rapid changes in my WBC.
Had I wisely titrated from 3.75 mg over a week, I wouldn't have gone through a week of pain to endure a few days of depressive psychosis ("I feel too self-conscious with this painful, blistering skin rash - and the painful neuralgia!"), only to recover a few days later, and make my psychologist's first interview.
Saturday, May 22, 5:02 AM
Addendum: If my math skills are up to snuff, it appears that mirtazapine's clinical trials have given enough statistics to help me calculate the number needed to cause harm.
That number is 17, but the odds are 1.25-1.75 to 1 that you'd get any one of the side effects. With paxil, the number needed to harm is 50, but the odds are like 2 to 1 i.e. you are twice a likely to get any side effect than you would with placebo.
Therefore, mirtazapine evens the odds ever so slightly. The only benefits in exchange for risk of lowering WBC that is appealing is its ability to tolerate nausea, and the lack of serotonin withdrawal symptoms which the SSRI and SNRI medications have in spades.
So I am going to build tolerance to mirtazapine by titrating using the hydration method i.e. dissolve 3.75 mg of the drug in about 250 ml water, let it sit for a few hours, and then sip it slowly.
Since that much water takes about 4-5 sips, I could titrate the drug over 4 hours, rather than ingest one half dose at bedtime. The only risk here is that of waking dreams, which the literature calls "hallucinations".
---
References:
- Ethnicity and psychopharmacology APT(1999), vol.5,p.91: http://apt.rcpsych.org/cgi/reprint/5/2/89.pdf
- A Psychiatric Residency Curriculum About Asian-American Issues : http://ap.psychiatryonline.org/cgi/content/full/26/4/225
Ethnopsychopharmacology: http://en.wikipedia.org/wiki/Ethnopsychopharmacology
Varicella Zoster virus: http://en.wikipedia.org/wiki/Varicella_zoster_virus
Zoster reactivation worst case: http://www.hivinsite.org/InSite?page=kb-05-03-01
Statistics involving pharmacology:
Number needed to harm: http://en.wikipedia.org/wiki/Number_needed_to_harm
Health Canada Database for Drugs:
http://www.hc-sc.gc.ca/dhp-mps/prodpharma/databasdon/index-eng.php
Both hydroxyzine and mirtazapine have lots of pages about their pharmacology and toxicology. The Health Canada website should have the main monograph to make the probability statistics.
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