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Ask Dr. Kaushik Your Own Question
Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4661
Experience:  MD Psychiatry
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Let me start by saying I am super sensitive to medication. I

Customer Question

Let me start by saying I am super sensitive to medication. I was put on 2.5 mg of lexapro. I am also on 7.5 mg of remeron and 200mg of Wellbutrin SR twice a day along with 6 mg of ativan which I am planning on tapering off of after I am stabilized
I ended up in the ER Wed. after my second dose of Lexapro on Tues. night with Serotonin syndrome. I have never had suicidal thoughts and agitation that was horrible. When can I safely start the new dose of remeron? My doctor is on vacation and his colleague will not make any med decisions since he has never seen me and I cant get in until next week. My
depression is breaking through again.
My original doc wanted to up the remeron before he left to 15mg since Ive had good signs with it, but I am afraid the lexapro is still in my system and will react with remeron again, but I skipped a dose of remeron and am having pretty bad withdrawls.
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Kaushik replied 1 year ago.


Welcome etc the site.

Kindly answer a few queries.

1) How many days in total have you taken lexapro 2.5 mg ?.

2) How many days back was the last dose of lexapro taken?Regards
Customer: replied 1 year ago.
Hi, I took one dose Monday night and one dose Tuesday night. Thank you
Expert:  Dr. Kaushik replied 1 year ago.

Well, only two doses of lexapro would not cause the drug to reach steady state plasma levels which is essential for any harmful interaction to happen between lexapro and remeron. So you should not have skipped remeron dose in the first place as there was nothing to worry regarding it interacting with lexapro. Anyways no matter how sensitive your body may be, but with use of only two doses you are absolutely not having any significant level of lexapro in the body for it to interact with

he remeron, so there is need to worry about raising the dose of remeron to 15 mg , you can go about doing it, however you need to keep your prescribing doctor informed about this. Also since you have skipped the dose of remeron recently so before you go up to 15 mg dose you got to take the present dose for atleast 5 days and then consider increasing the dose since the missed dose might have fluctuated the levels of remeron within your system. So to conclude you can increase the dose to 15 mg but since you have missed dose of remeron recently, take the present dose continuously for 5 days and then you may up the dose to 15 mg. i hope this helps and you are clear about what you can do.Wish you all the best.Please kindly leave a POSITIVE RATING if you are satisfied with the answer. Regards
Customer: replied 1 year ago.
Since I was diagnosed with serotonin syndrome and I see remeron can cause this by itself as well. I have been on small doses just for sleeping (7.5 and under). Today after NOT taking it, I feel much better. I only took my Wellbutrin 200 SR and 2mg of ativan both of which I have been on for about 18 years. A tonight they will probably try me on something else, what is your opinion of Serzone? Last questions, I promise. Laurie
Expert:  Dr. Kaushik replied 1 year ago.

Well, I would not recommend use of serzone since it has tendency to cause hepatotoxicity that is liver toxicity as a result of which it has gone out of favor in some countries and banned there. So I suggest that you bypass it's use as you have a good combination at hand with remeron and buproprion and you should be rest assured that this two drug combination will not lead to serotonin syndrome since these two drugs together do not lead to excess levels of serotonin in the brain which is seen in serotonin syndrome.

You see, had remeron been used with the likes of ssri anti depressants then the threat of serotonin syndrome would have been there because their concomitant use might have raised levels of serotonin to extremely high levels and cause serotonin syndrome. So you should go ahead with the use of buproprion with remeron without any hesitation, but ensure that since you have missed the dose of remeron recently, so stay put on 7.5 mg dose for 1 week before you up the dose to 15 mg of remeron.

I hope this helps.

Please kindly leave a POSITIVE RATING if you are satisfied with the answer.