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Positive Experiences With Adderall/remeron Combo


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#1 In_Remission_LucidSurreality

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Posted 12 December 2010 - 10:27 PM

I've been visiting this site a lot over the past two years, and I wanted to throw in my two cents regarding mirtazapine.

I started taking various forms of amphetamine to treat inattentive ADD near the end of 2008, and for a while things were pretty great. I didn't realize that I also had undiagnosed dysthymia/unipolar depression sitting under the surface, and I had been upping the dose of Adderall to around 30mg 3x daily to try and keep my mood up. After some life situation stuff came up, it finally hit me that I was getting really depressed, and after doing some research I suggested mirtazapine to my pdoc and he agreed that it sounded like a great idea. That was one of the best things that's happened to me, and I can't speak highly enough of this drug. I've been really surprised though, because when I look around, it doesn't seem like many people are talking about remeron. I'll try and highlight the key points on what it's done and why I think I'm having so much luck with it, and I'd be happy to answer any questions based on my on anecdotal experience.

Depression - I started taking it just over a year ago, and I was in a deep pit of a depression by the time I asked about it. In terms of efficacy, it was remarkable how quickly it turned things around. I started on 30mg, eventually upped to 75, and now am back down to 45mg. I haven't noticed any significant 'crapping out' in the antidepressant effect, so no complaints there.

Sleep - I've had trouble getting to my bed at a reasonable time and with sleep quality in general all my life. Stimulants didn't seem to do much one way or the other; after the initial insomnia, I returned to baseline, easier to get to my bed, less thought racing, but still not much luck sleeping reliably. Mirtazapine was a life saver. I'd tried taking melatonin on and off, but it didn't hold a candle to the H1 action of this drug. I've included a link below, because I want to point out the curvilinear dose response for sleepiness: at around 15mg, it knocks you out like a ton of bricks. As you increase the dose (to roughly 30mg and up for women, 45mg and up for men), it starts to have some alpha-2 adrenergic blocking, which helps attenuate the grogginess. Essentially, after taking it for about a month, I was sleeping better than I ever had in my life.

Appetite - I've been very thin my whole life, so my problem was much more in the realm of too little appetite. The adderall didn't help that, but it didn't hurt it much either after the first month. I'd estimate I lost around 5 pounds over that first year, and then gained it back over the last after adding the remeron. I've had insatiable sugar cravings my entire life, and I was already fond of eating Sugar in the Raw with a spoon. I noticed a definite increase in the cravings, but again after a month those returned to normal as well.

For those last two, I want to emphasize the 'also taking adderall' thing. I didn't mind the sedating effects of mirtazapine, because in the morning, I was waking up with amphetamine. Similarly, I have no idea if I would be gaining tons of weight if I wasn't also on a stimulant. With that said, for anyone dealing with a combo of ADD/Depression, I think this is a really cool combination.

I just think mirtazapine is pretty neat, really. Aside from the intense weight gain and potent sedation, the side effects are pretty minimal. It can be taken along side SSRIs to counter a lot of their nasty side effects (notably, sexual side effects). It seems to be pretty easy to discontinue, and it's not very taxing metabolism-wise. Overdoses don't seem to be too dangerous either. It's an anti-emetic; this was really cool, because I've gotten motion sick in cars my entire life. Now that I'm on remeron, I've been able to read books for hours while in a car, whereas before I couldn't get past a few sentences without wanting to die. It also cured my amphetamine headaches (and actually, my headaches all around. I used to get pretty bad tension headaches or something, but those seem to be gone too).

I'm sure there's more, but you get the idea. I feel very fortunate to have found a combination that seems to be working with my particular physiology. It's been such a rewarding experience, I want to share my results with anyone who's interested. I can't help wondering if people would have a lot more success if they stuck with it up to the higher doses.

Links:
http://en.wikipedia....iki/Mirtazapine (I'm pretty happy with the coverage of this drug on wikipedia)
http://www.preskorn....lumns/0003.html (more technical explanation of the curvilinear response and sedation)

Thanks for reading, and I hope this helps!




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#2 RleeP2

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Posted 13 December 2010 - 04:33 PM

I find this really interesting. I've been on 30mg Mirtazapine for about a year, along with a very low (3mg) regimen of diazepam. The valium was mostly for anxiety issues having gone through a bout of cancer in 2009 and I'm thinking about weaning off of it, as I'm pretty sure it somewhat amplifies the somnolence effects of Mirtazapine and some mornings. it is really tough to unglue myself from the bed. So, my anxiety is being handled and my depression is markedly less since I started on Mirtazapine.


But there is something missing. I have little motivation and when I do get up enough steam to try and concentrate on work-related projects (I'm a self-employed freelancer on fishing and environmental issues), I have an awful time sticking with them. I get distracted or I get confused or anxious that my focus is slipping away from me.

I thought once I found something that successfully addressed my depression, that a lot of these problems would resolve themselves, at least somewhat. But they have not. I'm not depressed (or not nearly as depressed) any more, but more and more, I don't think this is the whole of what is with me and holding me back.

I've always been this way for as long as I can recall and most of what I have accomplished professionally has come very hard won and with great difficulty, as if I were fighting some great fog. Its really frustrating.

I wonder if I should be screened for ADD? It couldn't hurt.

Thanks for some stuff to think about..

Edited by RleeP2, 13 December 2010 - 04:34 PM.

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#3 In_Remission_LucidSurreality

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Posted 14 December 2010 - 06:36 PM

Thanks for the reply, and I'm glad to have provided some material for consideration. Ever since I finally started treating my own ADD, I find myself seeing it everywhere. Two parts of your reply really jumped out at me:

But there is something missing. I have little motivation and when I do get up enough steam to try and concentrate on work-related projects (I'm a self-employed freelancer on fishing and environmental issues), I have an awful time sticking with them. I get distracted or I get confused or anxious that my focus is slipping away from me.

...

I've always been this way for as long as I can recall and most of what I have accomplished professionally has come very hard won and with great difficulty, as if I were fighting some great fog. Its really frustrating.


I'd definitely encourage you to get screened. Those quotes resonate a lot with my own experience. If it is something in the realm of ADD, adding a stimulant can have a profound effect on things.

I'll speak a bit to my own experience with Adderall specifically. When I take it, everything becomes clearer, life feels manageable, and everything just seems ok. Anxiety I didn't even know I was feeling dissolves, especially regarding time. Getting ready in the morning, time spent talking with friends between classes; it's like suddenly there's no rush, and I don't find myself 'losing time'. Doing mundane chores like laundry doesn't feel so aversive anymore, and playing games or checking facebook lose a lot of their appeal. It sort of levels the playing field, and it's a lot easier to choose what I want to spend my time doing. I no longer feel like I'm working against a gradient. Filtering out extraneous stimuli becomes markedly easier. I could go on, but I think that covers the gist of it.

I look forward to hearing about your experiences if you decide to pursue this further. I'd be happy to answer any questions you have as well, just let me know.

Best of luck!

#4 RleeP2

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Posted 15 December 2010 - 12:33 PM

Hi LS: Thanks for the reply and interesting additional information. As it so happens, I had an appt. with my P-Doc this morning. The usual 6 month meds management/tune up.
We talked for a bit and I raised the ADD issue with her, describing the feelings and difficulties as I did to you. Then I reminded her that 9 or so years ago, when I first saw her (she's the head of the local hospital's alcoholism/substance abuse center and when we moved out here, I only had a couple years sober, so I wanted to hook up with their resources), she wondered aloud then whether it might not be a good thing to screen me for ADD. But we did not pursue it. Today, she said, "Let's do it.." and sent me down for an EKG (since I'm 58, this would be preliminary to going on any stimulants). In the meantime, she upped my Remeron to 45mg and I guess we're going to see what that does and if it doesn't help, we'll go through the official diagnostic screening/process req'd for insurance and start a new script aimed at treating ADD. This will all be in February when I am to return to see her again.

So, we'll see. Thanks again for all the wisdom of experience you were willing to share. It may be the doorway to addressing something that has plagued me all my life.

We'll see and I'll keep reporting.
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#5 RleeP2

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Posted 15 February 2011 - 10:50 AM

Just a follow-up in general and in specific if Lucid Surreality is still around anywhere. I went back for my February follow-up with my P-doc this morning and I told her that at 45mg Remeron (which I started after our last session in Decemeber), I had a brief (about a week) period of feeling the best I've felt in a long time followed almost immediately by the loss of about half the improvement, a state which then stabilized and continues to this day. I don't feel really depressed, but I am having significant difficulty concentrating, focusing and getting motivated to work (I'm self-employed). There is a lot of noise in my head.

So, this morning, we talked some about this and she gave me the option of upping the Remeron to 60 mg/day or staying at 45 and doing a low dose Ritalin trial (5mg/day) for a few days to see what happens. I chose to try the stimulant. If it helps, she gave me a one month script for Adderall XR at 20 mg/day. I am to reserve filling this script until we see if the Ritalin helps. We should know if it is a fit for me within a few days by the way I respond to it.

So, we'll see...


I know these aren't large doses we are talking about for either med, but that's OK with me. I'm not a young guy (just turned 59) and I want to be cautious for the time being.

So, SR, if you're out there, thanks again for getting me thinking about this option. I'll report back on how things are going in a couple weeks.

Edited by RleeP2, 15 February 2011 - 10:52 AM.

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#6 In_Remission_LucidSurreality

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Posted 15 February 2011 - 11:09 AM

Thanks for the update! I'm around, just busy with classes. I'm looking forward to hearing how things work out for you - since my initial post, one friend has started taking both Adderall and mirtazapine to great effect, and another just filled his Rx for mirtazapine today.

Regarding the stimulants - I'm guessing that both will be of benefit. Ritalin is in the methylphenidate family, and Adderall is an amphetamine. They're similarly effective, with maybe a slight edge to the amphetamines, but in some cases a person might really improve on one and not the other. I'm glad you have a good relation with your P-doc, and I wish you the best of luck!

#7 peteysmom

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Posted 15 October 2011 - 03:14 AM

Just to add to this thread I also take Adderall and Remeron but I take them together. The Remeron at 60mg is not sedating for me so I take it with my morning dose of 40 mg of Adderall XR , I then also take a later dose of another 40 mg of Adderall XR. The Remeron had been the ONLY AD that seemed to work for me for quite some time but it was making me gain so much weight so making the switch to taking it during the day at the same time as the Adderall has really worked out. I have already lost about 10 pounds of the 60 I gained.
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My DX ARE: Hypothyroid, Gerd, Plantar Faciitis, MDD, ADD, PTSD

AM MEDS ARE; Synthroid 200mcg, Adderall XR 40 mg, Remeron 60 mg, Meloxicam 15mg, Toporol 50mg, Wellbutrin 300 mg, Pristiq 100mg,

2pm Med ; Adderall XR 40mg

9pm Meds; Trazadone 600mg, Sonata 10mg, Toporol 50mg, Mirapex titrating up from 0.125 to 0.75, Latuda 80mg, Topamax 75mg,

PRN: Hydrocodone 10/500 mg, Klonopin .05mg up to 4x a day

#8 RleeP2

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Posted 02 November 2011 - 04:39 PM

I'd all but forgotten about this discussion... 10 months into a 45mg a day Mirtazapine/20mg a day Adderall XR combo, I feel the best I've felt since college and that was over 35 years ago. I'm clear-headed, writing (my work, such as it is..) like a dervish (not all of it is worthwhile, but that's OK) and I generally look forward to every new day. This is a far, far cry from where I was a year ago.

I feel able, hopeful and content. I wish I'd done this long ago..
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#9 avenarius

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Posted 29 January 2012 - 05:55 PM

I've had success on this combo of 45mg mirtazapine and 10 mg generic adderall as well. I recently stopped taking the adderall because the mirtazapine was energizing enough, and I was having trouble falling asleep.

I haven't gained any weight after a month at 45mg, but I'm having some trouble with other side effects - trouble falling asleep, poor quality sleep, restless leg, respiratory depression, dry sinuses, sore throat (just a tickle). Still, I'd say it's the best antidepressant I've tried, and I've tried just about everything - ssri, snri, tricyclic, maoi, tianeptine, antipsychotics, etc. I can't tolerate the anticholinergic side effects (specifically - weight gain, sexual disfunction, and especially bad bladder problems) of ssri or snri classes - so remeron has been a godsend... so far.

I'd all but forgotten about this discussion... 10 months into a 45mg a day Mirtazapine/20mg a day Adderall XR combo, I feel the best I've felt since college and that was over 35 years ago. I'm clear-headed, writing (my work, such as it is..) like a dervish (not all of it is worthwhile, but that's OK) and I generally look forward to every new day. This is a far, far cry from where I was a year ago.

I feel able, hopeful and content. I wish I'd done this long ago..


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#10 AllinMyHead

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Posted 07 February 2012 - 10:30 AM

Wow. All of these posts make me feel very hopeful as I've been on remeron a couple of times now and have had to try and manage the weight gain and lethargy. This time, I asked my pdoc if it would be possible to add a stimulant. I'm on 7.5 mg of Rem for 5 days now and when I'm up to 15 and know that it's working, I'll try to add 2.5 mg of dextroamphrtamine in the am. I also take clonazepam 1.5 a night, but will see if I can come off that with the higher doses of remeron. That time I got to 45 mg and it pooped out on me after about 6 months. Hoping for a year this time. Right now eating chocolate morsels from the nestle bag. Guess I won't be making cookies.
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Experience with ECT (10 RUL Ultrabrief), Lamictal, Clonazepam, Trazodone, Abilify, Risperdal, Welbutrin, Cymbalta, Zoloft, Prozac, Dextromethamphetimine, Adderall, Strattera. Next up wean off of Trazodone and try Emsam patch (3->6 mg) to keep from relapsing

 

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#11 Finding 51

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Posted 11 October 2012 - 05:38 AM

I am also interested in the combo. I had a partial response on this drug. It stopped body agitation, anxiety, but did nothing for my depression and increased my irritability. Adderall improves my mood, stops anxiety, but makes my body agitated. I believe I was helped my mirtazapine's antagonistic effects on serotonin just as I am agitated by the increased serotonin activity of adderall. I think the two together could have a synergistic effect in me. I am glad to see someone else has had success on this combo. I plan to email my pdoc to inquire about it.
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Medications tried and failed: Wellbutrin, Citalopram, Effexor, trazodone, Lamitrogine, Mirtazapine (somewhat helpful), Abilify.

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