I don't know what to say. Except I hope you get relief soon.

I would say back off the combo. That way you try to isolate what's making this feeling happen.

In my humble opinion, from what you say, sounds like artemisnin is causing the symptoms.

I understand you're not liking it, but what if it's a herx?

Hope this lets up very soon!

I do take remeron occasionally to sleep and it works-i take 15 or 30 mg for sleep

IMO, I don't think you would notice much effect from artemisinin- how much are you taking?

Just my opinion, not a doctor. I stayed at a Holiday Inn too.

No wonder the heart palptations went crazy!
you can only take one antidepressant at a time i think...

janet....

quote:

---

Originally posted by pippy:
thanks guys!!!
I found out that it is called "serotonin syndrome" and is very serious drug interaction...
All these meds get crazy don't they???

---

Hi Pippy,

The SSRI's (eg Zoloft) are extremely powerful drugs; I have a friend who at 37 is now permanently disabled from them. Your doctor needs to keep a close eye on you as you withdraw from them.

Here is an FDA warning just out on Friday re SSRI's. I'll post separately some info on Remeron and Zoloft; hope this is helpful and that you get over this very soon.

Lisa

FDA Reviews Data for Antidepressant Use in Adults

In response to recent scientific publications that report the possibility of increased risk of suicidal behavior in adults treated with antidepressants, the U.S. Food and Drug Administration (FDA) has issued a Public Health Advisory (PHA) to update patients and healthcare providers with the latest information on this subject.

Even before the publication of these recent reports, FDA had already begun the process of reviewing available data to determine whether there is an increased risk of suicidal behavior in adults taking antidepressants. The Agency has asked manufacturers to provide information from their trials using an approach similar to that used in the evaluation of the risk of suicidal behavior in the pediatric population taking antidepressants.

This effort will involve hundreds of clinical trials and may take more than a year to complete.

In the meantime, the PHA advises health care providers and patients to be aware of the following:

 Adults being treated with antidepressant medicines, particularly those being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior.

 Close observation of adults may be especially important when antidepressant medications are started for the first time or when doses for the specific drugs prescribed have been changed.

 Adults whose symptoms worsen while being treated with antidepressants, including an increase in suicidal thinking or behavior, should be evaluated by their health care professional.

These recommendations are consistent with warnings already present in approved labeling for antidepressants used by adults.
FDA will provide updated information as it becomes available. The Public Health Advisory is available on line at http://www.fda.gov/cder/drug/advisory/SSRI200507.htm.

Mirtazapine (Systemic) REMERON

Other medicines--

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary.

When you are taking mirtazapine, it is especially important that your health care professional know if you are taking any of the following:

 Alcohol or

 Central nervous system (CNS) depressants (medicines that cause drowsiness) or

 Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil])--Using these medicines with mirtazapine may increase the CNS depressant effects

 Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate])--

Do not take mirtazapine while you are taking, or within 2 weeks of taking, an MAO inhibitor or you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, sudden high body temperature, extremely high blood pressure, and severe convulsions; at least 14 days should be allowed between stopping treatment with one medicine and starting treatment with the other

Other medical problems--The presence of other medical problems may affect the use of mirtazapine. Make sure you tell your doctor if you have any other medical problems, especially:

 Convulsions (seizures) (history of)--Mirtazapine has been reported to cause seizures rarely

 Dehydration or

 Heart disease or

 Stroke (history of)--Mirtazapine may make the condition worse by causing low blood pressure (hypotension)

 Kidney disease--Effects of mirtazapine may be increased because of slower removal from the body

 Liver disease--Mirtazapine may cause liver problems; also, effects of mirtazapine may be increased because of slower removal from the body

 Mania (a type of mental illness) (or history of)--Mirtazapine may cause this problem to recur

 Phenylketonuria (PKU)--The oral disintegrating tablets may contain aspartame, which can make your condition worse

Proper Use of This Medicine
Take this medicine only as directed by your doctor in order to improve your condition as much as possible. Do not take more of it and do not take it more often than your doctor ordered. ....

Precautions While Using This Medicine
It is important that your doctor check your progress at regular visits, to allow for changes in your dose and to help reduce any side effects.

Do not take mirtazapine with monoamine oxidase (MAO) inhibitors (e.g., furazolidone, phenelzine, procarbazine, selegiline, or tranylcypromine) or sooner than 14 days after stopping an MAO inhibitor. Do not take an MAO inhibitor sooner than 14 days after stopping mirtazapine. To do so may increase the chance of serious side effects.

Mirtazapine may cause some people to be agitated, irritable or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you or your caregiver notice any of these adverse effects, tell your doctor right away.

This medicine may add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates; medicine for seizures; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are taking this medicine.

Check with your doctor immediately if you develop fever, chills, sore throat, or sores in the mouth. These may be signs of a very serious blood problem that has occurred rarely in patients taking mirtazapine.

Mirtazapine may cause drowsiness or trouble in thinking. Make sure you know how you react to this medicine before you drive, use machines, or do other jobs that require you to be alert and clearheaded.

Dizziness, light-headedness, or fainting may occur , especially when you get up from a lying or sitting position. Getting up slowly may help. If this problem continues or gets worse, check with your doctor.

This medicine may cause dryness of the mouth. For temporary relief, use sugarless gum or candy, melt bits of ice in your mouth, or use a saliva substitute. However, if your mouth feels dry for more than 2 weeks, check with your medical doctor or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.

Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:
 Rare

 Convulsions (seizures); mouth sores ; sore throat, chills, or fever

Also, check with your doctor as soon as possible if any of the following side effects occur:

 Less common

 Decreased or increased movement; mood or mental changes, including abnormal thinking, agitation, anxiety, confusion, and feelings of not caring; shortness of breath; skin rash; swelling

 Rare

 Decreased sexual ability; menstrual pain; missing periods; mood or mental changes, including anger, feelings of being outside the body, hallucinations (seeing, hearing, or feeling things that are not there), mood swings, and unusual excitement
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

 More common

 Constipation; dizziness; drowsiness; dryness of mouth; increased appetite; weight gain

 Less common

 Abdominal pain; abnormal dreams; back pain; dizziness or fainting when getting up suddenly from a lying or sitting position; increased need to urinate; increased sensitivity to touch; increased thirst; low blood pressure; muscle pain; nausea; sense of constant movement of self or surroundings ; trembling or shaking; vomiting; weakness
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Brand Names
In the U.S.--
 Remeron  Remeron SolTab

Category
 Antidepressant
Developed: 03/20/1998
Revised: 01/25/2005

ps Note also that Zoloft can interact with St Johns Wort, which is used by some Lymies for brain-fog.

From MedlinePlus:

Sertraline (Systemic) ZOLOFT

....
Other medicines--

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary.

When you are taking sertraline, it is especially important that your health care professional know if you are taking any of the following:

 Astemizole (e.g., Hismanal)--Taking this medicine while you are taking sertraline may lead to a serious change in the rhythm of your heartbeat

 Flecainide (e.g., Tambocor) or

 Propafenone (e.g., Rythmol)--Higher blood levels of these medicines may occur, which may increase the chance of developing unwanted effects. Your doctor may change the dose of these medicines.

 Buspirone (e.g., BuSpar) or

 Bromocriptine (e.g., Parlodel) or

 Dextromethorphan (cough medicine) or

 Levodopa (e.g., Sinemet) or

 Lithium (e.g., Eskalith) or

 Meperidine (e.g., Demerol) or

 Nefazodone (e.g., Serzone) or

 Pentazocine (e.g., Talwin) or

 Selective serotonin reuptake inhibitors, other (citalopram [e.g., Celexa], fluoxetine [e.g., Prozac], fluvoxamine [e.g., Luvox], paroxetine [e.g., Paxil]) or

 Street drugs (LSD, MDMA [e.g., ecstasy], marijuana) or

 Sumatriptan (e.g., Imitrex) or

 Tramadol (e.g., Ultram) or

 Trazodone (e.g., Desyrel) or

 Tryptophan or

 Venlafaxine (e.g., Effexor)--Using these medicines with sertraline may increase the chance of developing a rare, but very serious, unwanted effect known as the serotonin syndrome.

This syndrome may cause confusion, diarrhea, fever, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, or twitching. If you develop these symptoms, contact your doctor as soon as possible

 Digitoxin (e.g., Crystodigin) or

 Warfarin (e.g., Coumadin)--Higher or lower blood levels of these medicines or sertraline may occur, which may increase the chance of having unwanted effects. Your doctor may need to change the dose of either these medicines or sertraline

 Disulfiram (e.g., Antabuse)--Disulfiram will react with the alcohol in sertraline oral concentrate and may cause serious problems

 Moclobemide (e.g., Manerex)--The risk of developing serious unwanted effects, including the serotonin syndrome, is increased. Use of moclobemide with sertraline is not recommended. Also, it is recommended that 3 to 7 days be allowed between stopping treatment with moclobemide and starting treatment with sertraline, and it is recommended that 2 weeks be allowed between stopping treatment with sertraline and starting treatment with moclobemide

 Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate])-- Do not take sertraline while you are taking or within 2 weeks of taking an MAO inhibitor. If you do, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, sudden high body temperature, extremely high blood pressure, severe convulsions, or the serotonin syndrome. At least 14 days should be allowed between stopping treatment with one medicine (sertraline or the MAO inhibitor) and starting treatment with the other

 Pimozide (e.g., ORAP)--This medicine should not be taken together with sertraline; tell your doctor if you are taking pimozide

 St. John's wort (Hypericum perforatum)--Use of this medicine with sertraline may increase your chance of getting serious side effects.

 Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil])--Higher blood levels of these medicines may occur, which may increase the chance of developing unwanted effects. Your doctor may check the blood level of the tricyclic antidepressant, and may change the dose of either these medicines or sertraline. Also, taking sertraline with amitriptyline, clomipramine, or imipramine may increase the chance of developing the serotonin syndrome

Other medical problems--The presence of other medical problems may affect the use of sertraline. Make sure you tell your doctor if you have any other medical problems, especially:

 Bleeding problems, abnormal or

 Purpura, or history of (purplish or brownish-red discoloration of skin)--Sertraline may make these problems worse.

 Brain disease or damage or

 Mental retardation or

 Seizure disorders (history of)--The risk of seizures may be increased

 Dehydration or

 Hyponatremia (condition in which your body has too little sodium)--Sertraline may make these problems worse, especially in older adults.

 Heart attack, recent or

 Heart disease, unstable--The medicine has not been studied in patients with these medical problems.

 Kidney disease--It is not known whether the chance of side effects will be increased

 Liver disease--Higher blood levels of sertraline may occur, increasing the chance of side effects. Your doctor may want you to take a lower dose or to take your doses less often than a person without liver disease

 Mania (history of)--May be activated

 Weight loss--Sertraline may cause weight loss. This weight loss is usually small, but if a large weight loss occurs, it may be harmful in some patients

Precautions While Using This Medicine
It is important that your doctor check your progress at regular visits, to allow for changes in your dose and to help reduce any side effects.

Do not take sertraline with or within 14 days of taking an MAO inhibitor (furazolidone, phenelzine, procarbazine, selegiline, tranylcypromine). Do not take an MAO inhibitor within 14 days of taking sertraline. If you do, you may develop extremely high blood pressure or convulsions (seizures).

Avoid drinking alcoholic beverages while taking sertraline.

This medicine may cause some people to become drowsy, to have trouble thinking, or to have problems with movement. Make sure you know how you react to sertraline before you drive, use machines, or do anything else that could be dangerous if you are not alert or well-coordinated.

Sertraline may cause some people to be agitated, irritable or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you or your caregiver notice any of these adverse effects, tell your doctor right away.

Do not stop taking this medicine without first checking with your doctor. Your doctor may want you to reduce gradually the amount you are taking before stopping completely.

This is to decrease the chance of having discontinuation symptoms such as agitation, anxiety, dizziness, feeling of constant movement of self or surroundings, headache, increased sweating, nausea, trembling or shaking, trouble in sleeping or walking, or unusual tiredness.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. One rare, but very serious, effect that may occur is the serotonin syndrome. This syndrome (group of symptoms) is more likely to occur shortly after an increase in sertraline dose.

Check with your doctor as soon as possible if any of the following side effects occur:

 More common

 Decreased sexual desire or ability; failure to discharge semen (in men)

 Less common or rare

 Aggressive reaction; breast tenderness or enlargement; fast, pounding, irregular, or slow heartbeat; fast talking and excited feelings or actions that are out of control; fever; inability to sit still; increase in body movements ; loss of bladder control; low blood sodium (confusion, convulsions [seizures], drowsiness, dryness of mouth, increased thirst, lack of energy); muscle spasm or jerking of all extremities; nose bleeds ; red or purple spots on skin; restlessness; serotonin syndrome (diarrhea, fever, increased sweating, mood or behavior changes, overactive reflexes, racing heartbeat, restlessness, shivering or shaking); skin rash, hives, or itching; sudden loss of consciousness ; unusual or sudden body or facial movements or postures ; unusual secretion of milk (in females)

 Incidence not known

 Abdominal or stomach pain; bleeding gums; blindness; blistering, peeling, loosening of skin; bloating; bloody, black, tarry stools; blood in urine; blue-yellow color blindness; blurred vision; chest pain or discomfort ; chills; clay-colored stools ; coma; cough or hoarseness ; darkened urine; decreased urine output; decreased vision; depressed mood; difficulty in breathing; difficulty in speaking; difficulty swallowing ; drooling; dry skin and hair; eye pain; fainting ; feeling cold; feeling of discomfort; feeling that others can hear your thoughts; feeling that others are watching you or controlling your behavior; feeling, seeing, or hearing things that are not there; fixed position of eye ; general feeling of discomfort, illness, tiredness, or weakness; hair loss; high fever; high or low blood pressure; hoarseness or husky voice; hostility ; increased coagulation times; indigestion; inflammation of joints; irritability; joint or muscle pain; large, hive-like swelling on face, eyelids, lips, tongue, throat, hands, legs, feet, and sex organs; lethargy; light-colored stools; lightheadedness ; loss of appetite; loss of balance control; loss of bladder control; lower back or side pain; muscle aches ; muscle cramps and stiffness; muscle trembling,

jerking or stiffness; muscle twitching ; painful or difficult urination; pains in stomach, side, or abdomen, possibly radiating to the back; pale skin; palpitations; puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue; rapid weight gain; rash; red, irritated eyes; red skin lesions often with a purple center; redness, soreness or itching skin; right upper abdominal pain and fullness; seizures; severe mood or mental changes; severe muscle stiffness ; shortness of breath; shuffling walk;

sore throat; sores, ulcers, or white spots in mouth or on lips; sores, welting or blisters; stiffness of limbs; stupor; sweating; swelling of face, ankles, or hands; swollen lymph glands; swollen or painful glands; talking or acting with excitement you cannot control; tightness in chest; troubled breathing; twisting movements of body; twitching ; uncontrolled movements, especially of face, neck, and back; unexplained bleeding or bruising;

unpleasant breath odor; unusual behavior ; unusual tiredness or weakness; upper right abdominal pain; vomiting of blood; weight gain; wheezing; yellow eyes and skin

 Symptoms of overdose--may be more severe than side effects occurring at regular doses or several may occur together

 Actions that are out of control; agitation; anxiety; bloating; blurred vision; change in consciousness; chest pain or discomfort; chills; coma; confusion; confusion as to time or place or person holding false beliefs that cannot be changed by fact; constipation; convulsions (seizures); darkened urine; decreased awareness or responsiveness; dizziness or fainting; drowsiness; fever; hallucinations; headache; indigestion; irritability; lightheadedness; loss of appetite; loss of consciousness; nausea; nervousness; pains in stomach, side, or abdomen, possibly radiating to the back; pounding in ears; seeing, hearing, or feeling things that are not there; serotonin syndrome (diarrhea, fever, increased sweating, mood or behavior changes,

overactive reflexes, racing heartbeat, restlessness, shivering or shaking); severe sleepiness; shakiness in legs, arms, hands, feet; shortness of breath; slow or irregular heartbeat; sweating ; trembling or shaking of hands or feet; unusual excitement, or restlessness; unusual tiredness or weakness; unusually fast heartbeat ; unusually large pupils; vomiting; yellow eyes or skin

Other side effects may occur that usually do not need medical attention.

These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:
 More common
 Acid or sour stomach; belching; decreased appetite or weight loss; diarrhea or loose stools; dizziness; drowsiness; dryness of mouth; headache; heartburn; increased sweating; nausea; sleepiness or unusual drowsiness; stomach or abdominal cramps, gas, or pain; trembling or shaking; trouble in sleeping
 Less common
 Agitation, anxiety, or nervousness; bladder pain; burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings; changes in vision, including blurred vision; cloudy urine; constipation; difficult, burning, or painful urination; flushing or redness of skin, with feeling of warmth or heat; frequent urge to urinate; increased appetite; pain or tenderness around eyes and cheekbones; stuffy or runny nose; vomiting
 Incidence not known
 flushed, dry skin; fruit-like breath odor; increased hunger; increased thirst; increased urination; redness or other discoloration of skin; severe sunburn; swelling of breasts (in women); unexplained weight loss; unusual secretion of milk (in women)
After you stop taking sertraline or when your dose is decreased, your body may need time to adjust. The length of time this takes depends on the amount of medicine you were using and how long you used it. During this period of time, check with your doctor if you notice any of the following side effects:
 Abnormal dreams; agitation; anxiety; burning, crawling, itching, numbness, prickling, "pins and needles" , or tingling feelings ; dizziness; electric shock sensations; failure to discharge semen (in men); feeling of constant movement of self or surroundings; headache; increased sweating; nausea; sleepiness or unusual drowsiness ; trembling or shaking; trouble in sleeping; trouble in walking; unusual tiredness
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Additional Information
Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, sertraline is used in certain patients with the following medical conditions:
 Premature ejaculation

Brand Names
In the U.S.--
 Zoloft

Just wondering how you are doing? It is difficult to figure out what to do when the mind isn't working either.

I got worse when I took antidepressants. I got depressed. It took the wind right out of my sails. I started thinking of ways to stop living.

Instead I stopped the antidepressants and the fight came back.

I know they help others so I think each one of us are different.

I can't recall how I did on the arteminsin.

I just know that when I don't know what is going on I tend to see how I am without the drugs first and then try them again one kind at a time.

They *FATALLY* can interact.

I was on zoloft and Zithromax at the same time for a few months!!!

Can this cause permanent brain damage...
I am scared because I am getting horrible headaches and major heart palpitations still today after being off for over 24 hours...

very concerned as to brain damage...
Has anyone accidentally done this and damaged their brain and other organs permanently??

Crime of lyme, thanks for your concern. I hope this did not happen to you or someone you know...
As far as the zoloft and zithromax fatal side effect, the pharmacist cross referenced it and really spent a lot of time looking for interactions there...he could find none and has heard of none...
it doesn't mean some people might not have this interaction...everyone is different. It has not been reported as at all common as an interaction, especially that can be fatal.
Maybe there has been one case somewhere?

I am off babs meds cuase it was too much for me TOO! We really ARE twins!

I had super duper dizziness and fainting, but it wasnt the same as you describe. Pretty sure mine was low lying babs that the mepron brought out. ?? will never know, eh?

Don't know which amino acids you are taking, but just be careful - tryptophan is on the list of things that interact dangerously with Zoloft.

Just saw this and your post to Doc Dave. I didn't know all this was happening! Whew! Some real fireworks for your Fourth.

First of all, it sounds like you weren't taking the combo of Zoloft and Remeron for very long. Is that correct? If so, then I think the worries about damage from drug interactions is fairly low.

If you have been taking the Zoloft for a while, then yes, you do need to go slowly to get off. I know how it goes, though.

I recently got changed to Topamax to manage my headaches. At the time I was taking huge doses of Oxycontin to try and handle my headaches. Once I started the Topamax, the headaches stopped. Felt like a miracle.

My doc said I could take less oxycontin, but didn't tell me HOW much less. I went down from 200mg a day, to 80mg a day, in one week.

BIG mistake!!!!!!! I wasn't in pain, but went through some very serious withdrawal. Took me a while to figure out that is what was going on, because I was using the pain as a guide for how much to take. DUH! It has more effects than just pain management. Oh, well, I proved to my docs that I'm not a drug addict!

Go easy on yourself. Make any changes slowly, so you can track the effects. You are keeping a good log of meds and symptoms, aren't you? That is SO helpful in figuring all this stuff out. I just note down all meds taken, and symptoms noticed. Takes less than five minutes at bedtime.

Go easy on yourself. You are learning a lot, but there is so much conflicting information, it can leave you almost paralyzed, not knowing which way to turn. Because you are so sensitive to meds, I would make changes slowly and carefully, so you have time to see how you respond.

Hang in there, girl! You have a lot of folks rooting for you.