Why Did Remeron Make Me So Sick?

QUESTION:

Dear Dr. Heller,

I've tried Remeron 30mg and thought I was going to die.  I was so out of it all day long felt like I had to sleep but couldn't and didn't know what I was doing.  It is a very bad drug for me.  I don't understand how you could say it works well with BuSpar since it's a very powerful drug unlike the SSRI's.  Could you explain or offer suggestions to taking BuSpar without it effecting sleep?  Or is it just that everyone is different?

Thank you.

ANSWER:

Some people are extraordinarily sensitive to Remeron, and you may be one of those people.  What I usually do for my patients in this situation is to try a very low dose for a day and see what happens (usually 7.5mg or 1/4 pill).   If that doesn't solve the problem doubling the dose to 60mg will usually stop those side effects.  The side effect profile of high and low doses is completely different and extremely bizarre.

For most people who need BuSpar and get sick on it, Remeron is a phenomenal addition.  If the Remeron cannot be tolerated I usually start with extraordinarily low doses of BuSpar and slowly and gradually increase the dose.