Help again

[abc30]

In my post "Please help" I put a question related with my fat liver and high cholesterol. I didn't receive a helpful answer yet. So again please help me to find a solution. This high level of cholesterol and triglyceride is because I take remeron, so what should I do? If I give up at remeron then I will fall in depression. I need a solution to continue to take remeron and in the same time to lower my cholesterol and triglyceride level.

[Dolphin14]

What does your GP suggest?

[abc30 in reply to Dolphin14]

my GP said to do what psychiatrist said.

[Dolphin14 in reply to abc30]

I would make diet changes, exercise and start the statin drugs. I wouldn't hesitate to change drugs either.

Just my opinion, not medical advice.

[abc30 in reply to Dolphin14]

Thank you for your message, I tried with diet and statin I don't want to take, I have had a colleague who have takes statin and in 1 years his liver become cirrhotic and died. Statin are very bad for liver.

[Mary-intussuception in reply to abc30]

Are you sure it was the statin that killed your colleague?

[abc30 in reply to Mary-intussuception]

This is what I understood, that statins start liver cirrhosis.

[EleanorRose]

I think this is difficult for anyone here to advise on as we’re not medically trained.

I definitely recommend talking to your GP. I saw in your last post that your psychiatrist had said not to stop on the remeron but they will mostly be concerned with your mental health. Your GP, on the other hand, will think more about your health as a whole and can discuss the pros/cons and what is the biggest ‘risk’ to you.

Have you ever tried any other antidepressants? Your depression could come back for a short while if you were to stop taking Remeron but perhaps there is another antidepressant that would work just as well for you with less side effects.

Good luck finding a solution. I hope someone can be more help than me.

Eleanor

[abc30 in reply to EleanorRose]

Thank you, my GP said that he cannot change psychiatrist medication and psychiatrist don't want to change it and suggested to start to take medication which lower cholesterol, statines. But in this way I will enter in vicious circle and finally I will destroy my liver.

[Mary-intussuception]

Eating porridge every morning brought my Cholesterol levels down to lower than ever.

I refused statins, but it was then accepted by the Medical Consultant that I didn't need them, following a big drop in my levels after 10 months. Don't know how long it took for them to come down due to the 10 month gap between tests.

You haven't said how high your Cholesterol and tryglyceride levels are.

It's helpful to give full blood tests results including numbers with the normal ranges in brackets, plus any lab comments. Have you been told that you have Hypertriglyceridemia ?

Is the fatty liver Non-alcohol fatty liver or alcohol induced fatty liver?

Unless a patient reduces high cholesterol levels with changes in their diet then I think most doctors suggest taking statins.

If you do a Google search asking how to bring tryglyceride level down - you will get helpful information including :

Lose weight (if obese)

Eat more fibre

Limit sugar intake

Eat fatty /oily fish twice a week

Exercise (gradually increase gentle exercise such as walking and / or swimming)

etc.

If the fatty liver is alcohol related, then the obvious thing to do is to abstain. With any liver problem, as far as I am aware, I think the advice is to abstain from alcohol anyway whether or not that was the cause.

Drinking water - a cup first thing in the morning, last drink of the evening and before & after every meal is a good general health tip.

It will also help a lot with healing your liver.

There are several things you could consider doing :

I)

Ask your GP for a referal to a Gastroenterologist. (Get full blood tests, checks and monitoring )

2)

Put a post on the British Liver Trust forum with some questions. (I don't know what the support is like on there but worth a try?) There may be more people on there, with these raised levels and fatty liver, who might share their experiences and knowledge with you.

3)

If in the UK you could call the;

British Liver Trust helpline, 10 am - 3pm on

0800 652 7330

and ask the Liver Trust Nurse if she has any suggestions as to the best way forward for you. You could ask if any of the medications you are on can cause fatty liver.

The liver can recover well with care.

[abc30 in reply to Mary-intussuception]

Thank you for your message. I tried with diet, and have had limited effect, my cholesterol decrease with only 20 mg, from 200 to 180 (the higher normal limit is 100), triglycerides are 500, and the higher normal limit is also 100. Probably the next step that I should follow is to go to another psychiatrist to try another antidepressant, I will do it after I will perform a new set of analysis probably next week.

[Mary-intussuception in reply to abc30]

I think you should ask for a referal to a Gastroenterologist.

Maybe ask for a referal to a Medical Consultant or Cardiologist too.

If I had this high Trygleceride result I would see it as a medical problem that I would want medical help with. However I am not medically qualified, but I would be asking for a diagnosis & prognosis. I would want advice from a Gastroenterologist or Medical Consultant.

Cholesterol :

Not sure what you mean by

" I tried with diet". For how long?

Healthy diet and exercise routine is a life commitment not a quick cure. Affect will be gradual. 20mg seems to me like an excellent reduction. If this keeps reducing you will get there if you persist.

Abstaining from smoking, alcohol, eating healthy high fibre diet, drinking water, exercise and keeping medication intake to a bare minimum - is usually the way forward.

However, I think I would still be asking for a diagnosis.

[abc30 in reply to Mary-intussuception]

Thank you, I didn't smoke or drink alcohol, more then that, I didn't eat also meal, no fats, no sweets, a lot of vegetables, rice and potatoes, this is my day by day diet for a past 3 years. But the results are disappointing.

[Mary-intussuception in reply to abc30]

Yes, I understand how these results must be disappointing for you, especially as you've eaten healthy foods the past 3 years.

A few points :

Is it possible that you're not eating enough (or enough variety) ?

I'm assuming you are vegan ? If not, would you consider adding some foods to your diet such as oily fish twice a week? We do need healthy fats in our diet.

If you are vegan do you supplement with Vitamin B12?

Have you had any blood tests to check any nutrients levels ? In particular :

Vitamin D

Vitamin B12

Folate (Vitamin B 9)

Ferritin

Calcium

If not, would your GP agree to test?

Nutrient deficiencies cause or contribute to health problems.

With regards to blood tests - do you have any other results? For example who told you that you have fatty liver? Were you also told you have raised LFTs (Liver Function Blood Tests ) results?

Have you had Kidney & Bone blood tests and FBC (Full Blood Count )?

Do you think these results are wholly medication related?

Another UK helpline with Specialist Nurses (Cardiac) who can be helpful is the :

British Heart Foundation

0300 330 3311

[abc30 in reply to Mary-intussuception]

The story is longer with my liver problem. One year ago I went to a Gastroenterologist and he give me a lot of analysis, more then you mention here. I also made MRN for liver where they saw a fatty liver. He didn't give me at that time statines but said if the problem persist and my psychiatrist doesn't want to change remeron, he will give me statines since this is the official treatment for high cholesterol. This was one year ago and since then I didn't see Gastroenterologist again( but I continue to make the bood tests recomanded by him). Related with diet I have more a mediteranean diet then vegan one, I eat also fish, once in a week.

[ruminating in reply to abc30]

Heard red yeast rice supplement is good for reducing cholesterol

[abc30 in reply to ruminating]

Yes, I will take it

[pandaeyes1]

Actually, mushrooms have a lot of natural statins in them!!

[abc30 in reply to pandaeyes1]

Thank you, I read also about red rice extract which is a natural statins, probably I will try it after I will perform a new analyses.

[pandaeyes1 in reply to abc30]

Yeah. There are actually a lot of natural statins in many foods. For the high cholesterol from mirtazapine, this should normalize after a few weeks. The medication itself can cause some weight gain and associated appetite changes. Has that been happening? I’d also suggest having your doctors refer you a dietician to help you as well.

[abc30 in reply to pandaeyes1]

Thank you, for me is more and more clear that I should stop remeron. On the other hand I am fear of depression. Anyhow is it obvious that I cannot solve them both in the same time (depression and triglyceride + cholesterol )

[Mary-intussuception in reply to abc30]

Rather than abruptly stop - could you gradually reduce dose?

Meanwhile, get some nutrients levels checked (mentioned above) and see if you need any prescribed supplements.

Once you have nutrients optimal you may find you can cope with less remeron ?? Just a thought.

In brief:

Your Psychiatrist says stop it; your GP says stop it.

Does this mean it can be stopped abruptly without side effects? Did you ask this question? My concern is - I knew nothing about this medication but have read that it should not be stopped abruptly.

Is this, in their opinions, the only way to reduce your Trygleceride level?

I've read that to come off it you need to reduce dose slightly at monthly intervals. So please double check with your GP with regards to stopping the remeron.

[abc30 in reply to Mary-intussuception]

Yes, I think if I will stop remeron it will be gradually.

[Mrspjsmom]

Can your doctor change your medicine to something other than remeron? You could also make an appointment with your primary care provider about this? There may be ways to lower it without another medication. Perhaps by diet or exercise. The most important thing is to keep checking your levels and do something before you have a major health issue. I take remeron and am required to have bloodwork every six months. I haven't had the problem you do but everyone is different.

[abc30 in reply to Mrspjsmom]

Yes, me also check blood at every 6 months, and now, in February, is time for a new check. I don't expect much differences with the last one. Related with doctors my intentionis to change my psychiatrist, may be he will give me another antidepressant.

[Mrspjsmom in reply to abc30]

Good luck. I'll be thinking of you.

[abc30 in reply to Mrspjsmom]

How long have you been take remeron? Few years? I take it 6 years and still continue with it.

[Mrspjsmom in reply to abc30]

I have taken remeron for close to 20 years. I take it at bedtime. In the morning I take Effexor. I was at the maximum dosage when they added remeron to help with sleep. I believe Effexor treats anxiety and depression. You may want to look into it if you're body is having problems with the remeron.

[abc30 in reply to Mrspjsmom]

Yes, it's strange that you don't have problem with cholesterol