Monday, November 3, 2008

Beating the weight gain of Remeron - Low carb diets?

It's no secret that I am one of many people out there that finally found a safe, effective & non-addictive medication to treat a rare form of intractable insomnia. My insomnia is a result of metabolic issues combined with your typical life stressors, which makes it difficult to treat and pretty much chronic.

For the past twelve years, I have struggled with various treatments for my insomnia in a desperate attempt to find those illusive zzzzz's. What I didn't know, was that while I was so hyper-focused on falling asleep that I didn't realize that the sleep I was getting was very poor.

After a string of ineffective, short-term medications whose side effects were worse than their cure, a new doctor I was seeing decided to try me on Remeron. Within days, I was sleeping like I had never slept before. I slept heavily those first few weeks, finding it difficult to wake up and get going in the morning. But, after I adjusted I started sleeping normally for the first time in years.

But, I (like many others) made a big mistake when I first started taking Remeron.....I ate. The doctor's will warn you that there is a risk of weight gain (mine said about 6-7 lbs), but what they should tell people is that the risk is actually reality and that most people end up putting on large amounts of weight.

I personally gained about 16 lbs, which, given my frame, is a pretty large weight gain. And, like many others, despite how much I exercised the weight kept piling on.

For weeks and weeks I was tormeted by the weight gain, as I exercised more and more. I tried to change my eating habits by not eating out, watching calories and being more aware of what I was putting in my mouth. But, the fact was that I wasn't a person who ate poorly, but was now a person who could not lose weight.

So, I started taking a hard, scientific look at Remeron and why it causes so many people to gain weight. I read up on the methods of action, the studies that link Remeron to a reduction in stress hormones (specifically cortisol) and how all of that could be connected to what was happening to people's bodies.

Here's what I noticed: I couldn't seem to build and maintain muscle mass. If I took a single day off of exercise, the fat would pile back on. After months of exercise, I had barely made a dent. But, then I also noticed that certain exercises seemed to create a bigger effect than others (more on that later) and that some days I could barely walk down the street because I felt so heavy and others I seemed to move faster and easier.

Not surprisingly, the research on Remeron talks alot about the weight gain, but, specfically, about the change in body composition. On Remeron, people tend to gain this layer of fat, or that's how I describe it. I call it the immovable layer of lard. It comes out of nowhere and is very stubborn about leaving. Walk all you want, hit that eliptical all you won't move. It makes you want to give up on the drug. To hate it. To return to insomnia, if that's what will make the weight go away.

But then I happened upon some like that lead me another link. And, that's when I put together the cortisol + insulin connection.

This is how it goes: Remeron supresses the stress hormone cortisol. This is one of the reasons it helps people sleep. It basically 'powers down' your brain and slows your metabolism a bit. But, more interestingly is the relationship between cortisol and insulin. Apparently, cortisol counteracts insulin. Insulin basically grabs sugar from your bloodstream and stores it as fat. Your body needs cortisol to counteract and balance this effect of insulin, in addition to helping processing lipids (fats) and proteins.

So, as Remeron is supressing your cortisol it is also contributing to some of the effects of high insulin, specifically hypoglycemia or low blood sugar. When people say that can't stop eating carbs on Remercon, this may be why. Unabated, the insulin is grabbing sugar out of your blood, which leads you to think that you are carb depleted. So, you eat more carbs.

That's problem number one.

Problem number two comes from simply supressing cortisol. Because optimal levels of cortisol are neccessary for processing all macronutrients, having too little of it a night could drastically effect your body's conversion of these nutrients into energy. This could cause weight gain and would explain why people gain weight on Remeron so quickly.

That's problem number two.

So, when I rethought all of this, I actually decided to try a little experiment: To eat a 'Zone' diet that focuses on balancing fats, proteins and carbs, to increase my B-Complex vitamins, add Omegas and incorporate more muscle building activities, such as weight training.

The diet gets rid of the carbs that the Remeron are making your body store as fat. The B vitamins help metabolize macronutrients and convert them to energy, omegas can help balance fat levels and muscle building exercise burns glucose and taps your fat reserves.

Three days and I lost 4 lbs.

So, there is hope. I am going to try and keep this up over the next week and see what happens. But, so far there has been a significant difference. And, given that losing ANY weight on Remeron is almost impossible, I am hoping that this actually works.

Keep ya posted....


Bazodee Bobolee said...

Hey there, thanks for this post! I have been searching EVERYWHERE to find someone with my same story, and it seems I have finally found you. Everything I google about Remeron and weight gain brings hits from people who are using Remeron for the anti depressant effect. But my doctor used it to treat my insomnia and I couldn't find anyone else who 1. uses Remeron for insomnia and 2. is gaining weight. I gained about 10 pounds over the past 6 months, most of it over the past 2 months. And all of it is around my tummy. At 5'9" and an initial 134 pounds, it looks very obvious (at least to me) since I have a characteristic "pot belly" look. I HATE it!

What you said really hit the nail straight on the head: I have these cravings for things like Smucker's jam and chocolate. I eat and eat and eat until I am sick and then I recover and eat more! I was wondering what the hell was wrong with me, until I read this. Thanks so much for writing.

Now, tell me, how has this diet been for you? Any further success? I would try it, but I don't know how I'd fare; I think I'd eventually give in after a short time and go back to my Smucker's jam jar and just spoon it out... :-/

diegopoole said...
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diegopoole said...

Dear Kate, I am a Spanish professor, and i found this post on your website with the same problem that I have. I am very surprised about your capacity of explaining and analysing the problem with Rameron. I began with Rameron five year ago, and I gain 20 kg. I have been looking for solutions in the web, and the best thing I found is your post. The question is that I do not know HOW to concrete the specific diet following the general indications you suggest. Also I would like to know how was the result of your diet.

diegopoole said...
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Paul Fitz said...

has the diet worked out for you? yours wa the first thing i have read regarding remeron weight gain that made sense...

lil said...

Anyone have any luck, I have been on the meds for nearly 2 years and gained 10 kg, I exercise most days for 1 hr.
Would love to hear from someone who has success,

threejay2927 said...

I am about to give up on the Remeron. I have been a small person ALL of my life until I started it. I do not like the way I look since I have gained so much weight. I want the old me back and it won't happen as long as I continue this med. I do not eat anymore than I did before but I still gained weight. It is like the Remeron slowed my metab down to zilch! I just can't stand it anymore. :(

Katy W said...

Kate - did you manage to keep the weight off? I'm struggling. This is my third round w remeron. It is the only thing that helps my deep depression. I need to stay on it. Katy

Heather said...

THANK YOU!!! I have been looking everywhere for some ideas as to what I could try to help with my Remeron weight gain. I suffered terrible insomnia for many years but also suffer from Post Traumatic Stress Disorder and Depression. Remeron is the first thing that ever really helped me live a normal, happy, regular sleep patterned life. The weight gain has been horrendous!!! Enough so to make me want to quit the Remeron but I fear equally returning to my old life. I am going to try what you suggested. It's the first real lead I've ever had. How are you doing now?

katididwhat said...

Hi all,

I noticed that people are still reading this and that it has seemed to make sense to people.

Many of you have asked for an update, so here goes:

I stopped taking Remeron in 2009 because I was able to change my life to accomodate the insomnia. Apparently I have an annoying combination of DSPD and anxiety (probably acquired over years of fretting about sleep). Naturally my body will fall asleep around 2-3am and I only have problems if I know I have to get up in the morning. That's when the anxiety kicks in and make the whole thing worse - leaving me with almost no sleep.

Unfortunately, my life has switched back to getting up early and struggling to get a good night's sleep. Stupidly, I didn't revert back to Remeron immediately and saw a few doctors who went with the benzos. Everyone who has dealt with long term insomnia knows how that pans out.

I'm headed back to the doctor tomorrow, sadly, to talk about tapering off the Restoril/Xanax. I'm both frustrated and embarrassed that I let a fear of gaining weight put me in this predicament.

I will ask to go back on the Remeron and, hopefully, take some time off from work to adjust to it.

As far as the weight gain, yes, the balance of proteins, fats and carbs works. Think about it, anyone who binges on carbs will gain weight whether they are on Remeron or not. Sticking to a high quality protein diet with good fats is not only a great way to eat but it will help curb the weight gain from the drug.

If any of you ended up trying the lower-carb approach, let me know. We'd all like to hear how it went with you.

wildfruit said...

Hello there , I have just started taking remeron 4 days ago after many unsuccesful attempts to cure my depression with sari's . Was a bit dubious to begin with due to the weight gain side effects that so many seem to go thru so after reading your blog Kate I started a low carb diet 3 days before starting the med , so far no cravings and no weight gain but I guess it's still early days am also exercising every other day I am really hoping that this is the answer to maintaining or ideally losing a bit of weight on this med . Would love to hear from you Kate or anyone else on their progress with remeron and the dreaded weight gain :)

wildfruit said...

Sorry that was meant to be ssri's not sari's lol

South Nowra Independent Floors said...
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JRL said...

I have been on Remeron since Sept. 2011. It helped immensely with my panic/anxiety/depression. I was 5'4" and 135lbs. I am now 170lbs. I did have cravings and would eat a pint of ice cream almost every night for weeks. I didn't gain weight initially. Then it seemed like my weight skyrocketed over night. The cravings are gone now, pretty much. Now I have this weight I have to get off. I tried weaning off of Remeron twice and both times it did not work out well. My symptoms came back within a week. I have decided that being mentally healthy is better than being thin. I am going to try to take in 1200 calories a day and walk on the treadmill. Hopefully, this will work with the weight gain. If not, at least I'm happy! I guess the main point I'm trying to make is to take things in perspective: weight gain is a small price to pay to get your life back!

Maybe. said...

Hi. Can I please say "thank you" and give you a big hug? I've always wondered about this and your experiences and scientific research (which, for the most part, is true) made me look at this in a new light.

Marjie said...

Thank you so much for this conversation! I've been on Remmy for 5 years. Gained 35 pounds overnight it seemed like and I have been trying to shake it for 4 years. It's slow BUT...I now take the tiniest amount possible to get to sleep and have gone after it with 5 days per week at the gym and can tell you that watching the carbs (plus no gluten, sugar, red meat, pork, fast food, soda) I have managed to lose 18 of the pounds. I do toy with the-"should I be skinny but crazy, or fat and sane" dilema. Until I figure out what the alternatives are, I battle it every day. Keep on it everyone!

Here's to a good night's sleep.

BriOnH said...

I am a type one diabetic for 36 years and on Remeron. I am also a trained Biochemist. I find your link between cortisol and insulin very interesting. I can attest that for me that could be why after I take Remeron I have to take massive amounts of insulin. My insulin to carb ratio is usually 1 unit for every 10g of carb, but at night when i literally binge eat, its almost 3:1.

I don't think hypoglycemia is a contributing factor though. When I was in college, studying biochem, people that used to smoke pot said they got the munchies from low blood sugar. I tested their blood and never found hypoglycemia to be the cause of 'getting the munchies'. Also it doesn't matter what my blood sugar is - it could be 60 mg/dl or 400 mg/dl - I crave carbs no matter what. Honestly carbs or not, I just crave food.

Lisa D said...

Hi Kate I am exactly like you, I suffered terrible insomnia for 3 years, I tried Temazepam, Zopiclone and had terrible side effects and withdrawal, my Gp then suggested Mirtazapine but I was reluctant to take an anti depressant but read that it had great sedation effects so gave in and took 15mg a night, it gave me the best sleep ever! Now 7 months on I have gained almost a stone (14lbs) in weight, I was always slim at 8 stone & 5ft2, I haven't eaten anymore than used to and go running 3x a week, no matter what I do I can't lose it. Tried tapering off the pills and now stopped completely but withdrawal is the worst, insomnia has returned, stomach cramps & nausea.. I am going to have to give in and take 1 tonight :0( what did your diet consist off? Is it cutting out carbs completely? Would love to hear how you are doing now. Lisa

Yogalover said...

Hi there! i just found this post......I am a 49 year old yoga/fitness instructor, and I have always dealt with chronic depression and insomnia. Thanks Dad! (jk) I currently take Wellbutrin 75mg/day which I have been on for 15 years, and I started Remeron 3 months ago.So, about 3 years ago my life changed dramatically in so many ways, good and bad, that I won't bore you all with details. The weight started creeping on and now I am sporting an extra 22lbs on my previously lean belly/midsection. I figured it was a combo of perimenopause and high cortisol. So, off to the expensive bio-identical hormone doc who put me on progesterone. We have been muddling around with hormones like testosterone, DHEA and pregnenolone for 2-1/2 years and I STILL have a protruding pregnant looking belly. I cannot adequately describe how much I LOATHE the way I look. I only just today found out that Remeron is a cortisol blocker! WTF? My cortisol levels are still through the roof!! I only take 15mg of Remeron/night and I do sleep fine now. Ironically, the Remeron has not caused me to eat more as I am very disciplined with food - I basically eat South Beach and as organic as possible - NOT a vegetarian. So, I went and bought some Phosphatidylserine to get my cortisol down. During my search to find an appropriate dosage, I found this post....I know a lot of folks would say "talk to your Doc", but, frankly, most doctors fail to impress me both professionally and personally. I'm sure there are tons of great Docs out there, but I cannot afford the time or money to go looking! Any ideas? I live in the Chicago area....

Michele Pence said...
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Sweetdreams said...

Hello, I have been on remeron since 1st part of June 2012.. I started it to help me come off a benzo I had been in for years.. Anyways I am almost off the Valium, I am only asking 1.5mg per day, cut three ways... So to make a long story short I have gained 15 pounds during this time.. I was really under weight when I started remeron b/c of the ibs I had from coming off the Valium.. I am 4'11 inches and went from 95 pounds to 110 pounds on the remeron... My normal weight before coming off benzo, etc was 103 pounds... Anyways, I tried several times (3) to stop remeron, but was not able to b/c it caused insomnia and made my benzo withdrawals worse, anxiety, etc.... So I went back on remeron and it doesn't help me sleep as well this time around, but I get 7 hrs off and on... I take 7.5 mg of remeron at night by the way... I have always been very fit, I've competed in 4 figure shows and have placed in each one.. So this drug definitely makes you gain weight, I have tried so hard to keep the weight off, but not much works.. It also makes me retain water... I am using myself as a test dummy, and trying different exercise regimes and I find when I do more cardio I gain more and retain more water... The week that I just weight lifted I was losing weight and then I added in cardio and it didn't help... It actually seems to make me heavier...
my Diet: I don't eat tons of carbs, just oatmeal in the morning... So I'll let you know how my testing goes... Next week I'm going to go back to just weight lifting and jumping rope to see if I start losing weight again.. I'm also in pray on this as well.. The Lord is amazing and a few pounds is nothing to him, if anyone can help me he can :-)

Mom2 4daughtersNana2 3 grandsons said...

I just picked up my first presc of remeron.I have had insomnia for almost 20 years,I dont even know what I havent tried.My latest presc was for doxepin 50 mg,I didnt know a body could stay awake for so many weeks.With the doxepin I craved carbs and without sleeping I gave in to eating alot.I used to take ambien for years but it took 20 mg a night and I still didnt sleep well.My problem,my Dr moved from Ky to Texas,and no other Dr would give me what I took.So, been to all different Drs promising they could get me to sleep,so far gained alot of wt,I.m so tired from not sleeping I feel its hard to move much which really adds to the wt problem.Isnt there any medicine that will help you sleep without wt gain?My current Dr has asked me to stop all restoril,I looked up remeron and am undecided what to do.After being overweight for years,2 years ago,I finally shed 40 pounds,this past 2 years I have gained 30 of it back.I am 5 ft 2 and am now back to 220 lbs,so to think about gaining alot more terrifies me.So in 4.5 hours I have to decide whether this one pill is worth being even never been depressed but the thought of getting bigger really does depress me.To know how many people cant stop this wt gain terrifies me.Whay do I do.I agree with the person who posted before me,I will pray for the Lord to help me,I know he can.I wish He would help me with my imsomnia so I wouldnt have to take all these awful drugs.If anyone has any other ideas on keeping the pounds off I would love for you to share them.God bless you all in sharing your thoughts to help others.

Mom2 4daughtersNana2 3 grandsons said...

My first time replying,thanks for listening(reading)

Amanda MacNeil said...

I have been on Remeron for 7 years. I suffer with anxiety and depression and was unable to sleep at night. My weight was 155 and I'm 5'9. Over seven years I am now 210 and 8 sizes larger. I have tried to go off this medication twice only for my symptoms to return in a week. I have tried.multiple diets including vegan only...and have managed to lose 15pds max. I feel uncomfortable on the meds and off. I crave food constantly and try to eat as whole and raw as food comes. I drink water .....bottom line weight is still increasing.

Kristen Roeder said...

I have been on Remeron for 10 years since my daughter was born. I have had insomnia for 15 years. I tried Doxepin, Ambien, Sonesta, Trazedone etc. Remeron works the best. I gained weight with my pregnancy and I struggle to lose it still but for the most part I think it is worth it. I have also started to take Seriphos (Phosphytidalserine)Sp? to lower cortisol levels since mine have tested very high at night. I have made some progress in the past few months and sleep with less and less Remeron. I used to take typically 7.5 mg every other night. Now I take it less and have gone for 4-5 days, typically sleeping5-6 hours. Not too bad. When I don't sleep I wake at 3 am wired and with no ability to sleep. I am also experimenting with low card diet but have been inconsistent since I feel tired with less carbs. I wish I could get off this drug and sleep like a normal person, however, I am also grateful for Remeron since my life is mostly peaceful and I manage a busy job and life. I weigh 160 at 5'5". I exercise most days and do not eat sugar, dairy, soda, alcohol or caffeine.

Mark Kucybala said...

I have been on 45mgs of remeron for about a year. I use it as a sleep aid and for depression. I have gained over 20lbs.My gut is huge. I,too crave carbs at night time.Munching on anything available. Finding cookie crumbs, candy wrappers in the morning. Sometimes I don't even realize I have "pigged" out until the next morning. I have been told to eliminate refined sugars. Eat protein. No pasta,bread and potatoes. Gonna give this a try. Also, I am not a fitness nut so I have chosen to walk 20 minutes daily.. Any other suggestionsss?

Blahnik27 said...

I have been taking Avanza for 6 months now. (15mg at night for insomnia & post-natal depression).
I initially gained about 25lbs in the first few months because those sugar/carb cravings are indescribable! I have always tried to follow a low carb diet, so decided to get very strict with myself and last month I ate very low carb (only 40-50 grams per day) and did cardio five times a week. I lost 13 pounds in 1 month!
Needless to say I am very pleased and will continue on.
I would like nothing more than to stop taking it all together, but fear going back to sleepless nights and constant anxiety.

Low carb and lots of exercise is the only way.

Jen said...

THANK YOU!! I know this post is years old, but I'm so glad I found it. I took Remeron for about 8 months, I gained about 20 pounds no matter what I ate or how much I exercised, so I decided to stop. I forgot how badly I sleep without it - 2 full weeks went by and I slept about 1-2 hours a night. I gave in and went back to the Remeron. I've tried EVERYTHING - Lunesta, Ambien, Trazadone, Xanax, Doxepin...I can't even think of them all to be honest. I'm so tired of the weight and feeling bad about myself, but it's worse to not sleep. Remeron has been a complete miracle in that department, I sleep great and wake up feeling great. No benzo hangover at all. It's hard to beat that, even if it means I have to be a little fatter. I'm going to try the Zone type diet and see if that helps, thank you!!

gabryele said...

I've been on remeron for 2 years and I didn't know about the weight gain when I was first put on it. I've put on a good 20lbs since starting the medication, and I have the same pot belly the a few of the other posters have. I've tried so many diets and it is just so difficult to loose this weight. I'm so tired of hating the way I look. So I've decided to go off of it. It just doesn't seem worth it to me. Especially after reading all these comments and seeing how badly others are struggling.

Sheri Wildt said...

Hi all,

About 15 years ago I had extreme anxiety and insomnia that rendered me pretty much useless. I was put on every possible SSRI but they all had horrid side effects. Finally, the doc tried Remeron and it was a miracle. Within a week I felt 100% better. At the time I was very thin, 104 lbs, but gained about 35 lbs in 4 months on it. The weight gain leveled off after that. I was on it for a year and safely came off of it and all meds. I never lost the weight, and gained 40 more over two pregnancies, but it was worth every lb gained to get my life back with this drug. After 15 years I am now having similar problems with anxiety but I weigh 178 lbs, so my doc doesnt want to put me on Remeron due to weight gain. He tried Lexapro, which is EVIL stuff, at least for me. I simply cannot do SSRI drugs of any sort. I would happliy diet and exercise to stave off the Remeron weight gain but I am not sure that will help. I am a bit disheartened because I know this drug works so well but I dont want to create other health problems with being morbidly obese.

spearear said...

Im in the UK where remeron is called mirtazapine, i have been on it for about 18 months.
Like everyone here I initially had massive carb cravings resulting in mass carbiside. I ballooned despite training and competing in triathlons.
Last year i went on a very low carb [ketogenic] diet; this diet definitely helps with symptoms of depression but also helps with weight management; what it hasn't done [yet] is get rid of the belly and i still feel like i have a layer of fat all over my torso. Lifting heavy weights has helped with body composition but i think that as soon as spring comes and this winter weather has gone that i will continue the ketogenic diet as this appears to be my magic bullet, but not the pills; sure they helped with some issues but they have also given me some issues...catch 22 really!
I did not know about the cortisol suppression; why are we not told the full story by the pharmaceutical companies i will never understand.
Feel free to check out my twitter feed for lots of low carb and ketogenic information @colin__matthews

sixty something said...

It's helpful to find all these comments about weight gain.... I know my psychiatrist is thrilled to see me in remission from depression...I was too at first....I was euphoric and very the weight gain is indeed as someone described it - a layer of aft all over my torso. After my husband died I worked so hard to lose weight and now I am fairly shattered to find I've regained all that weight. I 4pm my body feels like lead...I salivate passing food....then I eat....I try but I find the addiction to food is much worse than alcohol...Will I continue with Remeron...I'm really not sure....?

lzahart said...


I know this post is oldish but I can't tell you how good it makes me feel. I have been on Remeron for about 4 months. I knew it caused weight gain because it had in the past when I had been put on the drug-- however I had rapidly asked to stop as a result. This time, my depression was so bad, the doctor wanted to try anything that works at all, so they pulled Remeron out. Well..

In the past 4 months I have gained over 30 pounds. I have always had a thin frame and am tall but have also always been slightly inclined towards thinking skinny is better. Never had an eating disorder. Never been a stress eater-- if anything I am one who doesn't want to eat when depressed or upset. At first I thought I must be doing something wrong, so I exercised more. Then I thought maybe I'm eating something wrong, so I saw a nutritionist. However after over 2 months on a strict diet of 800 calories a day and 2x serious cardio a day, I still weighed more-- and not in a muscle type of way, in a fat around my belly that I have never had before type of way.

I have been off this medicine for about a week and have already lost 4 pounds. I hate that I am going to have to work off this weight but will do it because I can't imagine going through life like this.

My doctor subbed in another antidepressant and I know that it takes time to ramp up/get the effects of the drug, but I would rather deal with the ramp up time and sleep loss and other side effects than not be able to look in the mirror when I'm getting out of the shower because it is so shocking and disturbing.

I have an excellent doctor and when I hesitated on the Remeron because of past weight gain, she convinced me that it was better to be fat and alive than skinny and not. I agree with that. But if the choice isn't life or death, if it's milder than that, then I would strongly suggest anyone going on this medication do some reading. Doctors don't seem to be anywhere near as aware of this issue as this post.

Thanks again for helping me understand I am far from the only one who has experienced this bizarre rapid weight gain and insatiable appetite!

Macco said...

I have to thank all who have posted to share their experiences with Remmy and weight gain along with the never ending munchies. I have had exactly the same issues with Remeron. I have gain an excessive amount of weight and continue to eat less and less every week only to stay the same weight.

For the past 2 years I have taken 120 of Remeron for Major Depressive Disorder and Generalized Anxiety Disorder. It has done great to help me manage both mental illnesses. I actually have not had a depressive episode for the past 9 months. It is so great to be living in a "normal" state vs being depressed for years at a time.

But the negative body image caused by the weight gaining effects of Remeron are taking its toll on me. My joints ache from the weight. I'm embarrassed to be seen by anyone or to go out in public or parties.

I don't know what will happen to my mental illnesses if I go off Remeron. I also take other antidepressants and mood stabilizer meds.

I'm going to try the weight training and low carb approach as well as asking my psychiatrist if I can start to come off Remeron. Hopefully I will be able to come off it and start to lose the 100 pounds I've gained from it.

I'm grateful to be alive and hope to see if I can live a good physical and mentally healthy life without Remeron.