# Questions about Remeron, and weird doctor feelings



## Amelie (Jul 24, 2007)

I have longstanding [35+ years] chronic [24/7] dissociation, in the forms of both depersonalization and derealization; for a brief while, the DR had improved, but it came back--and basically stayed. It all started following a very traumatic sexual event (rape). Right now there are two issues I'd like some input on.

First, I started taking Remeron a few days ago for chronic, drug resistant insomnia. The first night--and into the next day--I slept for the better part of 16 hours (on a 15mg dose); I was a complete zombie all that day. Second night I reduced the dose by half; slept pretty well that night and wasn't as zombie-like the next day, but still very tired. Third night (last night), I stuck with the 1/2 dose--and barely slept at all; however, I awoke with a terrible, terrible headache. (More on that in a moment.)

On the day after my first dose I started feeling REALLY STRANGE...something was happening with my DP/DR, but I couldn't tell if it was making my dissociation worse (my first impulse), or better--which would be so foreign I wouldn't recognize it!







Things look/feel/seem different; I don't know what else to say to describe it.

So my questions are, has anyone experienced either worsening dissociation or an improvement in their dissociation after starting Remeron? I so want a 'cure' for this thing that has been the bane of my existence for so long...I would love to hear that others actually improved on Remeron. And what about horrific headaches?

Next issue...primarily for the women here.







I had brain surgery last year to remove a tumor. As part of my team, my neurosurgeons brought in an internist I started seeing a few weeks before surgery; I saw him daily in the hospital, and then for followup visits afterward in his office. I have had female primary care physicians, gynecologists, and breast surgeons for many years--by conscious choice--but since this was for brain tumor-related care it didn't matter to me that they were all male, including the internist. What I didn't expect going in was that I would end up seeing him a lot due to post-op complications/problems--and grow to like him. Over the last year+ I've gotten very comfortable with him, and actually ended up asking if I could see him as my primary physician, and he said yes. (The words, as they came out of my mouth, surprised even me! But it was a very logical move.) I like him, I trust him implicitly, I feel extremely confident in him because he's very thorough and always really THINKS everything out, considers everything, before making any decisions. So at last week's visit I scheduled an appointment in January for a physical. By the time I got home panic had set in as I started obsessing over what that meant.

Despite having seen him many, many times and being very relaxed and comfortable with him, he's never examined me...you know...THAT way. I cannot believe I'm panicking over this, but I am. I just don't have MALE physicians for stuff like pelvic/rectal/breast exams. Haven't for many years...and it's freaking me out. I'd probably tell anyone else feeling this way, "he's seen it all a million times...it's just another day at the office for him..." Somehow, though, when it's *ME* it's different! Is that weird? Is all of this weird?

I'm not kidding when I say I'm panicking/freaking out over this. My heart starts racing just thinking about it, and that's not good. One of the biggest post-op issues we've dealt with is very high, very drug resistant blood pressure and heart rate. (The terrible headache I had this morning--which may or may not be related to the Remeron--was reminiscent of the horrific headaches I had daily when my BP was 100 points higher than it is now, so it was pretty scary.)

I KNOW it's in my best interest to follow through on the decision I made to see him as my PCP, because he's not only a GREAT physician but we've been through so much together. I'd rather have my care in his hands than some other doctor who doesn't know, and really understand, all the details like he does.

Oh, something I should mention because I just know it'll come up! I know it works for some people, but having another female in the room during the exam would NOT help me. It actually would stress me out more. And don't ask me to explain how because I really don't think I can. It's just how it is.

Well, I'd appreciate any thoughts, advice, ideas, reassurance...whatever. (And thanks for reading this woefully long post!







)


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## insaticiable (Feb 23, 2010)

Regarding Remeron:

I have been on Remeron for about a year and a half (way before my DP/DR started, so I can't say how it effects my dissociation), and have had no terrible side effects from it, except for the weight gain it causes due to increased appetite. I don't know if your doctor told you this or not, but at higher doses (say 45 mg or 60 mg), Remeron is actually LESS sedating. I don't know the exact mechanism behind that, but I have found it to be true in my own personal experience. I don't believe I experienced any headaches. Remeron can be used as a sleeping-aid, and it is also VERY effective for treatment-resistant depression. I did not respond well to any SSRIs or SNRIs, but Remeron was good in the aspect of reducing my high levels of depression. However, I will add though that my theory is that antidepressant medications may effect the DP/DR/dissociated brain differently, and you may experience side effects that you would not otherwise have pre-DP/DR. The reason I say this is: My doctor is in the process of tapering me off of Remeron and switching me to Anafranil (a highly effective OCD medication, also shown thru recent research to have positive effects on DP/DR), and the very next day I began experiencing some really bizarre and uncomfortable sensations (such as stiff arms and legs, confusion, etc), whereas when I tried the Anafranil at the young age of 13, I had virtually NO side effects, so my hunch is that my brain is responding to the medication differently now since I have become dissociated. I hope this makes sense. Please feel free to respond back if you have any further questions regarding the Remeron.


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## FoXS (Nov 4, 2009)

Amelie said:


> Next issue...primarily for the women here.
> 
> 
> 
> ...


oh my god, i am happy that you survived this ! fuck DP/DR and everything, there are so much more dangerous things !


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## Amelie (Jul 24, 2007)

FoXS said:


> oh my god, i am happy that you survived this ! fuck DP/DR and everything, there are so much more dangerous things !


Thanks.







You're right, there are much bigger, more dangerous things than DP/DR. Ironically, though, everything else I've faced, including assorted serious illnesses, have bothered me less than the DP/DR. At least with physical illnesses, you can explain the symptoms, have tests, get a diagnosis [even if it takes years...like my brain tumor did], and be "cured." With DP/DR, time marches on and nothing ever happens to make it better.









The brain surgery was quite an experience. The day before surgery, one of my neurosurgeons told my husband and me that there was a 1 in 500 chance of not surviving. We were appropriately shocked by that. A year later, I was reading a journal article he and one of my other neurosurgeons had contributed to--and found out that, in fact, the odds were 1 in FIFTY. He added a zero to make it less frightening right before surgery.









It's been a long and very difficult road recovering from the surgery, but I'm alive! I still have some facial paralysis (which continues to improve), hearing loss on the operative side (that's gone for good), vision changes (permanent), dry eye and mouth (both on the operative side, permanent), balance issues (improving), and ongoing exhaustion/fatigue (improving). And even with all that, I'm very pleased to say I made it!


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## Amelie (Jul 24, 2007)

I'm surprised by the lack of response to the doctor issue.







I KNOW [from many years of therapy, including group therapy with other dissociatives] that medical exams for people with a history of sexual abuse can be really hard and stressful. So I know I'm not alone! Surely there are people here who get what I'm panicking about...


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## Visual (Oct 13, 2010)

*I KNOW it's in my best interest to follow through on the decision I made to see him as my PCP, because he's not only a GREAT physician but we've been through so much together. I'd rather have my care in his hands than some other doctor who doesn't know, and really understand, all the details like he does.

Oh, something I should mention because I just know it'll come up! I know it works for some people, but having another female in the room during the exam would NOT help me. It actually would stress me out more. And don't ask me to explain how because I really don't think I can. It's just how it is.*

Perhaps your husband could come with you.

Everyone has buttons that can be pressed. Recovering from rape could add some really big buttons.

You need to look and the risk/benefit ratio - What is he going to provide you as the PCP that your other doctor didn't? If it pushes fear, DP, etc. then why do it? Logically he could be helpful regarding your surgery since he was there and you get along well. But usually what a PCP does is very routine, portable. You may wish to proceed for 'therapy' reasons - recovery from fear, but this is serious stuff and you should talk with your therapist about it. What does your husband think about it?


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## razer777 (Jun 28, 2010)

couldn't you just ask that for this particular physical that you'd like a female physician to exam you?


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## Amelie (Jul 24, 2007)

I was without an Internet connection for weeks thanks to storms in Southern California that knocked out *MANY* AT&T customers' wiring...including mine.







I'm finally back online and wanted to post an update.

First, I took myself off the Remeron after a miserable week of absolute zombie-like existence, even at half the prescribed dose. But after a short break I went back on it, titrating up SLOWLY from 1/4 dose, taking about 4 weeks before getting back up to full dose. And I'm glad I did! It's actually had an amazing--and wholly unexpected--effect on my panic/anxiety issues, which normally leave me in a cold sweat, shaky, feeling faint when I go out [like to a supermarket I've been to a million times]. I was NOT expecting that at all, so it's been a surprise, but most welcome, blessing.









Next, my appointment is next week for the physical, and while I'm still somewhat freaking out over it, it's not as bad. I think I've done a good job of reasoning with myself, i.e., thinking about WHY I wanted this doc to be my primary doc in the first place--I LIKE him. I'm comfortable with him. I trust him. And after all we've been through together it just makes sense.

In response to razer's comment: No, it's not possible to ask for a different [female] doctor because he's in private practice. So it's just him. But I'm basically okay with it now. I'd be lying if I said I'm not at ALL panicky about it, because, well, I am! It's just really weird for *ME* to have a male doctor for stuff like this after all these years. And with my sexual abuse history, I don't know...it's hard to explain coherently, and even other women who've been raped may not feel the same way, but for me it's been a big deal to feel...protected?...I don't know...just not be exposed [literally] in that way with male doctors. Rape is a strange thing and can totally fuck with your mind, even years later, and even though no doctor had anything to do with the crime. At any rate, next week at this time it'll all be over with!


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## Emir (Nov 20, 2010)

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## Amelie (Jul 24, 2007)

Thank you, j4, for the thoughtful comments. I think part of the problem with this doc is that in the year and a half I've been seeing him, it's been more like sitting around with a friend chatting, and now all of a sudden it's not! When it comes to confidence in a doctor, I honestly could not have more confidence than I do in this doc. He's really that good. And it's important to me that he knows everything about my brain tumor, its surgery, and its complications, so when he considers an issue he's looking at it with more depth of knowledge than another doctor could/would. I have multiple issues--complex issues--I want to address, some of which have plagued me for years, and he's the first doctor I've seen in ages who I REALLY believe will be able to sort it all out.

Also, I'm tired and disgusted by the way modern medicine is so compartmentalized, i.e., one doctor deals with this area of the body, another with this other area, another with that area, and so on, and the result is that a complex issue either gets overlooked or I get passed from one doc to another. That happened with my unexplained anemia a couple years ago--my [then] primary care doc sent me to a rheumatologist, then she sent me to a GI doc, then he sent me to a hematologist, who sent me back to the GI doc...it was an endless circle of tests, being told it must be the other guy's area, and we never did figure out WHY I was horribly anemic.









I don't want my primary care spread out over several different doctors any more. I just want one, HIGHLY competent doc who can deal with just about everything, and this guy is it. He can't help it if he happens to be male!


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## Emir (Nov 20, 2010)

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## Amelie (Jul 24, 2007)

j4mtj said:


> I hear you. If you are comfortable with him otherwise, maybe telling him your oncerns about the physical issues (if you haven't already) will allow both of you to work together to be alert to any reactions you may have and ease the way for you.


That's my plan! Up until now there's never been a reason to tell him about my past [in terms of rape, etc.], but now there is. It's definitely in my own best interest and, really, his too, to tell him.

I found a GREAT article that's aimed at doctors about treating women who have sexual trauma histories; I highly recommend it to anyone who's either dealing with similar issues as mine or just wants to understand it better: Sexual Trauma: Information for Women's Medical Providers. I may print it out and take it with me to my appointment.



> I wish you all the best with this!


Thanks! I'm thinking it's going to turn out to be one of those things where, in retrospect, one goes "WHY was I all worked up about THAT?!"


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