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Well you see Tianeptine ( available as brands such as stablon or coaxil or tatinol) is a very safe and effective SSRE class anti depressant ( quite opposite to the ssri anti depressants like prozac therefore no problem is associated with serotonin levels but it has a problem with availability since it is not available in the US, but if you can get it availed under the guidance of your doctor then this drug will be a good and safe alternative for remeron.
You shall start taking it a dose of 12.5 mg / day as a single dose in the morning for 1 week followed by 12.5 mg dose in the morning and in the afternoon for 1 week and then taking 12.5 mg dose three times a day and maintaining on this dose as it is the effective dose schedule. Kindly do discuss this with your doctor.
Now before you get started on tianeptine it will be advisable to come off remeron albeit you being on a very low dose and this can be brought about by taking the current dose of remeron on alternate days for 1 week and then stopping the drug completely and then after a gap of 2 days you shall start on tianeptine in the above mentioned pattern.
Also may I add here that tianeptine being a safe drug is also safe with your underlying endocrine problem.
I hope this helps to answer your query.
Wish you all the best.
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