Mass Hunger

[SEANML]

Lol I can handle the weight but the catch is... I had a Nissen Fundoplication last year. So this craving has led to some crazy times. May have busted my surgery. So my only question is, who has lasted over 6 months and knows tips on the cravings maybe foods that fill you up. I feel the urge for sugar, massive amounts of sugar lol, but I use to drink syrup (no diabetes thank god lol ) So whats your story! I cant stop and wont stop this med. Dr gave me stims for my adhd and I am still hungry!
Amazing medication, many years to find this solution with a nasty side affect. My mom told me the hunger I describe is like a diabetes patient (she has type 2) my sugar is low.
I somehow do a 24 hour fast once a week but I cant fight it any longer and its painful lol, insanity ( completed 1 fast, doing one right now! I want to do a 48 hour one day. I hear it can help discipline hunger.

~Sorry for my rough english, I have a hard time typing due to a brain injury :) I do apologize~

[panic_down_under]

I cant stop and wont stop this med

I understand the desire to stick with a med that works when others haven't, but also consider the bigger picture. How good is a med that might be causing you real long term harm? You might not be diabetic, atm, but the intense carbohydrate craving is likely taking you down that path and with a family history of the disease you are at higher that usual risk anyway. Mirtazapine isn't really that good an antidepressant. It mostly relies on sedation and there are other meds which may give you a similar outcome without the hunger issue, for example trazodone (Desyrel, or preferably the extended-release Oleptro formulation).

You could also try eating a moderately high protein, moderate fat (mostly unsaturated) and low carb diet, but the mirtazapine induced carb cravings are not going to make it easy, especially at the beginning.

[SEANML]

I understand the desire to stick with a med that works when others haven't, but also consider the bigger picture. How good is a med that might be causing you real long term harm? You might not be diabetic, atm, but the intense carbohydrate craving is likely taking you down that path and with a family history of the disease you are at higher that usual risk anyway. Mirtazapine isn't really that good an antidepressant. It mostly relies on sedation and there are other meds which may give you a similar outcome without the hunger issue, for example trazodone (Desyrel, or preferably the extended-release Oleptro formulation).

You could also try eating a moderately high protein, moderate fat (mostly unsaturated) and low carb diet, but the mirtazapine induced carb cravings are not going to make it easy, especially at the beginning.

Truth is, I already use trazodone 200mg plus 30 mg mirtazapine to sleep. 200mg trazodone use to put me to sleep and then it stopped after years of use. mirtazapine and amitroptiline have worked well for mood and sleep but I stopped ami cause of the ana scare, and having a harder time passing waste lol.Also couldnt even flex my stomach muscles and that was only 20mg. I dont like seroquel and the drug benzos hurt my brain. Mirtazapine has this calming effect makes me so worry free. Not a fan of ssris either, evil side effects for me.

Daytime I do not use anything, stopped my stims just cause... it really makes you mood so medium so boring, was on 60mg Ritalin on 10 mg increments. Solves hunger but definitely can make your personality different.I take a 20mg CBD pill in the morning and there is my day :) Plus coffee all day. Not much water when I come to think of it lol.

Ooo also I can fight the urge to eat sugars. I eat fruits all day and I am fine, sure some syrup would make me feel amazing but I just wont drink it, sometimes I will take a raw cane sugar pack once in the night if I am driving lol, but no more insane drinking of it.

[panic_down_under]

Truth is, I already use trazodone 200mg plus 30 mg mirtazapine to sleep. 200mg trazodone use to put me to sleep and then it stopped after years of use.

The thing about trazodone, and also mirtazapine to a lesser extent, is that the higher the dose the lower the sedation. Trazodone is typically far more sedating at 25mg than 200mg and it pretty much disappears completely at the recommended 300mg+ for anxiety and depression, especially with slow/extended release formulations which are better at keeping plasma levels above the sedation threshold.


mirtazapine and amitroptiline have worked well for mood and sleep but I stopped ami cause of the ana scare,

The added risk of heart disease from TCAs is small, the risk from mirtazapine weight gain and diabetes is much higher with the risk from uncontrolled anxiety and depression being higher again.


and having a harder time passing waste lol.

Increasing fibre and water intake often lessens TCA induced constipation.


Daytime I do not use anything, stopped my stims just cause... it really makes you mood so medium so boring, was on 60mg Ritalin on 10 mg increments. Solves hunger but definitely can make your personality different.I take a 20mg CBD pill in the morning and there is my day Plus coffee all day. Not much water when I come to think of it lol.

Ooo also I can fight the urge to eat sugars. I eat fruits all day and I am fine, sure some syrup would make me feel amazing but I just wont drink it, sometimes I will take a raw cane sugar pack once in the night if I am driving lol, but no more insane drinking of it.

Again, taking/eating stuff with far more potential negative health effects compared to the small added TCA risk.

[SEANML]

I hate the positive Auto Immune and Rheumatoid factor for Amitryip, My biggest fear is auto immune disease, right beside cancer. Other then that I would take amitriptiline in a second. Also hair loss from it is scary :P My doctor retires in a week and this is the last chance I have if I wanted to change. I wont have a doctor for a few months.

I have health anxiety that I overcame but seeing the auto immune risk just scares me shitless. I can avoid diabetes by not eating that sugar :P But my surgery paid for it. I dono its a tough one, I just wonder if anyone has stayed on it long term conquering hunger?

Do you know anyone who was on mirtazapine long term successfully? Or amitrip

[panic_down_under]

I hate the positive Auto Immune and Rheumatoid factor for Amitryip,

Just because something is listed as a potential side-effect doesn't mean the med actually causes it. The lists are compiled from drug trials reports and list everything that is reported, even things that can't possibly be caused by the med such as bacterial and viral diseases. I have been only able to find one case report involving antinuclear antibodies (ANA) and amitriptyline and the AD was used to treat the condition, not its cause. Like many TCAs, amitriptyline is a potent antihistamine which can significantly ease immune disorder symptoms and may prevent them in some circumstances.

BTW-anxiety and depression are arguably themselves the results of an autoimmune response which kills brain cells in the hippocampal regions of the brain. ADs work by stimulating the growth of new cells - see: Depression and the Birth and Death of Brain Cells (PDF (https://www.americanscientist.org/sites/americanscientist.org/files/20057610584_306.pdf)) and How antidepressant drugs act (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025168/)..


I have health anxiety that I overcame but seeing the auto immune risk just scares me shitless.

A little knowledge is a dangerous thing. You are taking meds which have a far higher risk of doing you harm because of a potential risk which probably doesn't exist.


Do you know anyone who was on mirtazapine long term successfully? Or amitrip

People have taken both for decades without issue.

[SEANML]

Just because something is listed as a potential side-effect doesn't mean the med actually causes it. The lists are compiled from drug trials reports and list everything that is reported, even things that can't possibly be caused by the med such as bacterial and viral diseases. I have been only able to find one case report involving antinuclear antibodies (ANA) and amitriptyline and the AD was used to treat the condition, not its cause. Like many TCAs, amitriptyline is a potent antihistamine which can significantly ease immune disorder symptoms and may prevent them in some circumstances.

BTW-anxiety and depression are arguably themselves the results of an autoimmune response which kills brain cells in the hippocampal regions of the brain. ADs work by stimulating the growth of new cells - see: Depression and the Birth and Death of Brain Cells (PDF (https://www.americanscientist.org/sites/americanscientist.org/files/20057610584_306.pdf)) and How antidepressant drugs act (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025168/)..



A little knowledge is a dangerous thing. You are taking meds which have a far higher risk of doing you harm because of a potential risk which probably doesn't exist.



People have taken both for decades without issue.


You are being of great help. This is bringing me closer to changing. Also starting to get alot of light headed issues now. Fell over when I woke up lol.
That anxiety/depression bit is a good read thanks :) I always thought ami was harder compared to mirtaza.

Thanks for checking up on the auto immune thing, that was my only biggeest concern with amitrip.
I read I cannot take it with my trazadone though (been on traz for over 15 years.)

[SEANML]

You are being of great help. This is bringing me closer to changing. Also starting to get alot of light headed issues now. Fell over when I woke up lol.
That anxiety/depression bit is a good read thanks :) I always thought ami was harder compared to mirtaza.

Thanks for checking up on the auto immune thing, that was my only biggeest concern with amitrip.
I read I cannot take it with my trazadone though (been on traz for over 15 years.)
Might go talk to talk to my dr tomorrow. Just dono the proper dosing. Did ami at 20mg last time.
It was a good medicine (amitrip when I used it, just got all paranoid with the having a positive ana once . )

[panic_down_under]

I read I cannot take it with my trazadone though (been on traz for over 15 years.)

You could, though your doctor would likely baulk at prescribing amitriptyline at therapeutic doses together with 200mg trazodone a day. Anyway, why take a med that apparently isn't working?


Just dono the proper dosing. Did ami at 20mg last time

The usual starting dose is 75mg/day in 2-3 divided doses, though I suggest you ask to be started on 2 x 10mg for the first week, increasing to 2 x 20mg for another week before taking the full 75mg, either as 3 x 25mg/day, 25 mg in the morning and 50mg at night, or the whole 75mg at night. I've found I do better taking TCAs in 2-3 divided doses, but YMMV. Amitriptyline is a fairly potent antihistamine, not quite as potent as mirtazapine, but close, which should help you sleep at night. Most end up taking 100-150mg/day for optimal results.

Either trazodone and mirtazapine could still be taken at low hypnotic doses if needed, but the CBD oil could be counterproductive if it contains more than a trace of d9-THC as this can damage hippocampal brain cells. I wouldn't trust the makers claims on this as regulation of supplements is poor and substitutions and dose variations are common. Are you still taking ritalin, and if so why was it prescribed, for ADHD, or to counter mirtazapine sedation and/or weight gain?

[SEANML]

You could, though your doctor would likely baulk at prescribing amitriptyline at therapeutic doses together with 200mg trazodone a day. Anyway, why take a med that apparently isn't working?



The usual starting dose is 75mg/day in 2-3 divided doses, though I suggest you ask to be started on 2 x 10mg for the first week, increasing to 2 x 20mg for another week before taking the full 75mg, either as 3 x 25mg/day, 25 mg in the morning and 50mg at night, or the whole 75mg at night. I've found I do better taking TCAs in 2-3 divided doses, but YMMV. Amitriptyline is a fairly potent antihistamine, not quite as potent as mirtazapine, but close, which should help you sleep at night. Most end up taking 100-150mg/day for optimal results.

Either trazodone and mirtazapine could still be taken at low hypnotic doses if needed, but the CBD oil could be counterproductive if it contains more than a trace of d9-THC as this can damage hippocampal brain cells. I wouldn't trust the makers claims on this as regulation of supplements is poor and substitutions and dose variations are common. Are you still taking ritalin, and if so why was it prescribed, for ADHD, or to counter mirtazapine sedation and/or weight gain?

adhd and for my chronic fatigue. That is what the ritalin is for.

Got all my dosing changed 15 mg mirtaz and 10 mg ami at 100 mg traz
Then 25 mg traz and 15 mg mirtaz and 20 mg ami :) Will help with my Fibromalgia too I heard. Pharmacist told me to stop worrying about side effects lol.

[panic_down_under]

Hey have you ever use amitrip?

No, but about 8 years on the similar imipramine and the last 25 on another TCA, dosulepin.

[SEANML]

adhd and for my natural chronic fatigue. That is what the ritalin is fo.

Today I woke up very confused. I will be calling my dr today. Not feeling myself, kind of oddly disconnected.


Hey have you ever use amitrip?


You honestly never saw anything about ana with this stuff?

[panic_down_under]

You honestly never saw anything about ana with this stuff?

No, and I've been on similar meds at much higher doses than you're likely to ever be, 350mg for imipramine which is well above even the maximum inpatient dose, and 225mg for dosulepin. Nor have I heard of anyone else doing so in the 20 or so years I've been participating in support groups. Given amitriptyline is used to treat ana symptoms it would hardly be surprising that sometimes someone will have an increase while on the med. Doesn't mean it was caused by it. If you treat a lot of people with a med which can make their condition worse then that should become obvious very quickly.

[SEANML]

No, and I've been on similar meds at much higher doses than you're likely to ever be, 350mg for imipramine which is well above even the maximum inpatient dose, and 225mg for dosulepin. Nor have I heard of anyone else doing so in the 20 or so years I've been participating in support groups. Given amitriptyline is used to treat ana symptoms it would hardly be surprising that sometimes someone will have an increase while on the med. Doesn't mean it was caused by it. If you treat a lot of people with a med which can make their condition worse then that should become obvious very quickly.


Thank you for all this information, it has greatly relaxed my anxiety towards this medication.
Dr says just carefule with my ritalin dosing due to the serotonin syndrome

[panic_down_under]

Dr says just carefule with my ritalin dosing due to the serotonin syndrome

This is not an issue. Methylphenidate (Ritalin) is an extremely weak serotonin reuptake inhibitor and amitriptyline is only a moderate one. The only TCAs which inhibit serotonin reuptake sufficiently for serotonin syndrome/toxicity (SS or ST) to be a potential issue are clomipramine (Anafranil) and imipramine (Tofranil). To quote Dr Ken Gillman (http://scholar.google.com.au/citations?user=ea6KeD0AAAAJ&hl=en), one of the two guys on the planet who knows most about serotonin syndrome/toxicity (SS or ST):


"for instance, methylphenidate (which is classified as an amphetamine) seems to be mainly a DA re-uptake inhibitor, and not a releaser. It produces no risk of ST or a pressor response."

from 'MAOIs and releasers, including amphetamines (https://psychotropical.com/maois-and-releasers-including-amphetamines/)' at his website

The Canadian Family Physician's clinical review 'Demystifying serotonin syndrome (or serotonin toxicity)' (PDF (https://www.cfp.ca/content/cfp/64/10/720.full.pdf)) makes the same points:


"Tricyclic antidepressants are also serotonin reuptake inhibitors, with clomipramine and imipramine being the most potent and likely the only TCAs to be involved in serotonin toxicity; other TCAs such as amitriptyline are weaker inhibitors and are thus unlikely to cause toxicity.

Serotonin releasers: Serotonin releasers cause more serotonin to be released from the presynaptic terminal into the synapse. Serotonin releasers include amphetamine, but not methylphenidate, and the illicit drug ecstasy (3,4-methylenedioxymethamphetamine)."

The one issue with the combination is amitriptyline may increase the effects of methylphenidate so some dose adjustments to the latter may be needed and your doctor needs to monitor this. Such drug interactions are why medications have to be prescribed and not sold over-the-counter and your doctor should be able to manage this. It is his/her main job.

[SEANML]

thank you for that info :) I go visit my new doctor in January. But I see my main family doctor next week (for the last time) :)
Current dr just said "be careful" lol. I know alot but I dont know Serotonin syndrome, never had it luckily

Can you suggest other meds like traz/mirt/ ? Just to give me other ideas to read up on and maybe discuss with a doctor? Seroquel was a fail :P and benzo is horrid on my brain injury.

I am trying the amitrip again but too be honest I hate starting new meds and side effects :P . I didnt even like Mirtazapine . I was able to sleep on just 200mg traz for 20 years lol. Something went horribly wrong and not I am trying all these drugs that have weird side effects :P Traz never had side effects for me :P

Supposedly amitrip can be a really good drug if I give it it's chance. But I just have fears of side effects you kno a worrier :P

[panic_down_under]

I know alot but I dont know Serotonin syndrome, never had it luckily

It is much, much rarer than Dr Google suggests. Very few doctors have ever seen a genuine case. It is something more likely with MAOI class ADs.


Can you suggest other meds like traz/mirt/ ? Just to give me other ideas to read up on and maybe discuss with a doctor? Seroquel was a fail :P and benzo is horrid on my brain injury.

I think TCAs and SSRIs/SNRIs are better bets than some of the marginal ADs such as mirtazapine (which is more sedative than antidepressant).


I am trying the amitrip again but too be honest I hate starting new meds and side effects :P .

The only people who are happy at the prospect of starting an AD are those who've never been on them. They are a necessary evil. The thing to keep in mind is that while the initial side-effects can be unpleasant, they are rarely a sign of harm.


I was able to sleep on just 200mg traz for 20 years lol. Something went horribly wrong and not I am trying all these drugs that have weird side effects :P Traz never had side effects for me :P

You were lucky. Trazodone is just as capable of producing severe side-effects as any other AD. It all comes down to how a med meshes with individual biology. Interestingly, however, trazodone can counter some common SSRI/SNRI side-effects.


Supposedly amitrip can be a really good drug if I give it it's chance. But I just have fears of side effects you kno a worrier :P

Unfortunately, in addition to our main anxiety disorder many of us also get med phobia as a freebie. Personally, I would have preferred the steak knives! :sad:

[SEANML]

Hmm have you hear much about Nortriptiline?

[panic_down_under]

Hmm have you hear much about Nortriptiline?

It is a TCA which mostly inhibits noradrenaline, aka norepinephrine reuptake. It can be very effective and is definitely worth a try if serotonin biased reuptake inhibitors prove ineffective, or intolerable. Old school psychiatrists would treat treatment-resistant depression by combining it with a SSRI, usually sertraline, to essentially create a bespoke SNRI, but most psychiatrists these days seem oblivious to the potential/advantages.