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Thread: Mianserin or Tolvon

  1. #41
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    Jul 2012
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    Re: Mianserin or Tolvon

    Quote Originally Posted by MyNameIsTerry View Post
    It could be good news, she may have found an alternative to try? It may even be she didn't realise about the costs and when weighing up the benefits it's not the best to try for you? But she still needs to do something and it's not like you've tried all the med options from what I've read here.

    Cost issues do get in the way even for more mainstream meds e.g. Pregabalin, where some doctors won't prescribe it due to costs and even some local CCG's blacklist it creating a postcode lottery issue

    No the news was she was going to start me on a very very low dose to try and avoid side effects but I told her I just got put on a anti sickness tablet,I mentioned earlier I have a stomach problem as I was being sick a lot so gp has put me on these tablets and now I can’t go on mianserin as the anti sickness could cause serotonin syndrome, so I really don’t know how long il be on anti sickness and she said okay we will just wait til you’re off the anti sickness,I asked if I could try something else , again, and she said no... so my depression anxiety and everything isn’t going to be sorted anytime soon as my stomach problem isn’t going to go away. Yes I may come off the anti sickness but I can’t see a gastroenterologist until March 2020,only if something bad happens. I don’t know what they want to happen I was took into hospital the other day with this problem but nothing was done or moved forward.... I’ve been on pregabalin they used to be hard to get prescribed them but seems to be gp’s favourite tablet to prescribe at the moment. My son is on them now. They aren’t doing him any good, but that’s his choice he’s 25 he just hasn’t got the guts to say what he thinks to his psychiatrist where as I gave up caring n said exactly what I think and feel.

  2. #42
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    Jan 2017
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    Re: Mianserin or Tolvon

    Quote Originally Posted by beautifulfreak77 View Post
    No the news was she was going to start me on a very very low dose to try and avoid side effects but I told her I just got put on a anti sickness tablet,I mentioned earlier I have a stomach problem as I was being sick a lot so gp has put me on these tablets and now I canít go on mianserin as the anti sickness could cause serotonin syndrome,
    What is the anti sickness med? Even without knowing I'm very sure the claimed serotonin syndrome risk is nonsense, but I'll save further comment until I know which med you've been prescribed.

  3. #43
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    Re: Mianserin or Tolvon

    I read the leaflet it does mention it, but I thought I’d be okay on a small dose, the anti-sickness is Ondansetron.

  4. #44
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    Jan 2017
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    Re: Mianserin or Tolvon

    Quote Originally Posted by beautifulfreak77 View Post
    I read the leaflet it does mention it, but I thought I’d be okay on a small dose, the anti-sickness is Ondansetron.
    I thought it might be it, or another of the 'setrons.

    I don't have time to get into this as deeply as I'd like now so will reply in more depth about it tomorrow, but you have as much chance of developing serotonin syndrome from taking ondansetron and *mirtazapine together as you have of flying to the Moon by flapping your arms.

    I might also have some good news about ondansetron too.


    *Edit: Oops, I meant mianserin, not mirtazapine
    Last edited by panic_down_under; 19-08-19 at 02:59.

  5. #45
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    Re: Mianserin or Tolvon

    Quote Originally Posted by panic_down_under View Post
    I thought it might be it, or another of the 'setrons.

    I don't have time to get into this as deeply as I'd like now so will reply in more depth about it tomorrow, but you have as much chance of developing serotonin syndrome from taking ondansetron and mirtazapine together as you have of flying to the Moon by flapping your arms.

    I might also have some good news about ondansetron too.

    I shall look forward to your more in depth message about it tomorrow, ooo good news would be nice, and make a change.

  6. #46
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    Re: Mianserin or Tolvon

    Okay, firstly, ondansetron, mianserin and serotonin syndrome/toxicity (SS/ST). The product info leaflet list SS/ST because the muppets at medicine regulators such as the FDA, WHO and I assume the UK's Medicines and Healthcare products Regulatory Agency wouldn't know serotonin syndrome if it slapped them across the face with a halibut. This isn't my opinion, but that of SS/ST experts such as Ken Gillman and others:



    Demystifying serotonin syndrome (or serotonin toxicity) (PDF, p724)

    The 'setrons aren't the only meds for which the muppets have gotten SS/ST badly wrong. Worse when presented with the evidence of their error the usual response is to dig their heels in, block their ears and sing LALALALA.

    Bottom line: Ondansetron can't trigger SS/ST because it has no known impact on serotonin transporters which is the central requirement to induce SS/ST.

    Mianserin also can't trigger SS/ST because it is an extremely weak inhibitor of serotonin reuptake. In the past mianserin was often prescribe together with SSRIs, just as its analogue mirtazapine is now. The ability of a drug to bind with receptors and transporter molecules is measured in Ki units which are based on the amount of the drug needed to saturate receptors/transporters. The less drug required the lower the Ki. Mianserin's value for the serotonin transporters (SERT) is about 4,000 Ki. To put that into perspective the value for the most potent SSRI, sertraline, is 0.21 Ki, and for the least potent, citalopram, it's 1.38 Ki. You would have problems physically swallowing enough mianserin to equal the serotonin reuptake blocking ability of a single sertraline dose, and even if you could SS/ST would be the least of your worries.

    But this isn't the only reason mianserin can't induce SS/ST. The danger of the syndrome is the large spike in body temperature it causes. This can become high enough to kill. The potent 5-HT2A antagonists (blockers) cyproheptadine and chlorpromazine are the recommended treatments for preventing the temperature spike. Mianserin is also a fairly potent 5-HT2A antagonist which could counteract the temperature spike if ondansetron and mianserin were capable of triggering SS/ST.

    Now for some potentially good news re ondansetron. I first heard of this med from my then psychiatrist who had been following its drug trials back in about 1990. All the indications were that it was a highly effective anti anxiety med, particularly for panic disorder, which not only had fewer side-effects than antidepressants, but could also ease nausea, a common anxiety symptom. So we both waited and waited for it to come onto the market, but it never did, at least not for anxiety. It seems the eyes of the Glaxo beancounters lit up like the Sydney Harbour News Years Eve fireworks when they realised how effective it was in blocking chemo and radiation therapy triggered nausea and how much cancer clinics were prepared to pay for it. While it was in patent it was selling for US$5 a tablet, wholesale!

    It is still fairly expensive, though maybe not as much as mianserin, so while you may not be able to get it prescribed for anxiety at least you get to have a test run and hopefully enjoy a significant reduction in anxiety levels while you're on it.

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