Dear group,

My dad started to develop severe, body wide peripheral neuropathy a few years ago over a period of months at age 48. Like many on this board, he went to many doctors, had many tests, added many lifestyle changes with diet, exercise, supplements, etc. He has many ups and downs, but we take heart from so many of you in the same situation.

At this point he's at "many drugs" which are very helpful in making the neuropathy bearable enough to continue working.
Pain= 75 fentanyl patch every 2 days, 3 10mg hydrocodone in Norco breakthrough each day, 3600 neurontin (in 4 doses), 2 mg klonopin (in 3 doses)
Alertness= celestial black seasoning tea plus 200 provicil each morning
eyes= lots of regular, moisturizing eye drops
He also takes testim gel (testosterone) to counter the opioid effect on hormones, and something for constipation

The Fentanyl works pretty well, but he developed more of the a depression over time. The first day on the patch he feels pretty good, but by the afternoon of the second day he feels quite low.

His pain clinic doctor and his neurologist (after many doctors, these two seem the most knowledgable) recommended "remeron or mirtazapine, which is a different type of antidepressant.

It's only 1 week starting at 7mg and going to 15mg per day and results are mixed. We thought he felt better , but then he felt worse and now he's not sure if he wants to keep taking it.

He had terrible trouble with about 5 other antidepressants- 2 tricycles and 3 ssri's. Terrible anxiety attacks were caused by those attempts. Remeron has not caused any of that, but at first he felt too sleepy and then although he felt more awake, less depressed, he has also experienced more pain. A coincidence?

This is long, but we're wondering (those of you on six or seven meds like my Dad), does anyone have experience with Remeron? Good, bad, how long to adjust dose, etc. It's hard to know what's doing what with so many meds.

The opioids/neurontin/klonopin have been the most effective buffer against major major pain (he still has pain of course, you all know how he feels). But is it possible to counter the depressive effect the opioids have? Testosterone helps, provigil helps. Is it possible Remeron might help too? He was very excited and happy when he seemed to be feeling better, but then 1 week later he's very depressed that he has increased pain.

Any comments/feedback will be very appreciate! Thanks so much!

Remeron is the most sedating of the antidepressants. So for an elderly person, starting very low in dose is the best way. 7.5mg is a common in the nursing home population. I would stay at that dose for a month. 15mg used to be the starting dose, but for people who have alot of sedation from this drug, the newer 7.5mg might be best to start with, and a week only at this may not be enough. Some people stay on 7.5mg...so go slowly.

Remeron is used alot because it stimulates appetite which can be poor in the elderly also. So don't be surprised at weight gain.

Remeron can affect the blood system, so make sure your dad gets monitored for that.