Remeron: The Dream Drug

This drug does not seem to be discussed much in psychonaut communities, though it comes up in lucid dreaming communities, mental health communities, and a few others. This drug is prescribed as an antidepressant and sleep aid oftentimes. Unlike most other sedatives and antidepressants, this drug increases REM sleep, which may underlie some of it’s interesting effects. Its’ potential as a psychonautic agent is clear but its’ contextualization as a treatment for depression seems to imprison its’ identity in the eyes of people. I was prescribed Remeron for almost a third of my entire life, so I figured I would honor this magical substance and do a post on it. First, I describe my subjective experiences with this drug and then later there is a section on hypothetical pharmacological explanations for such effects.

Disclaimer: Before exploring my reaction to this drug, it is important to note that others may not experience the same thing. Even while I took this medication, I did not experience all of these effects constantly, though it was pretty frequent, especially when I first started on it. I also do not recommend others to try this drug outside of being prescribed.

Dosage: The dose of the majority of my experiences was 15mg, often dosed sublingually, which seemed to produce a more intense effect and strange mouth numbing.

One of the first times I took Remeron, I fell asleep quickly, sinking into a heavy sedation. About an hour later I woke up feeling as if I had slept for 6 hours. I noticed that it was 10:00. The sensation of a long sleep was so convincing that I believed I had slept for over 12 hours and woken up at 10:00 AM the next day and was already late to school. Realizing I had only slept a single hour was utterly shocking. I drifted back into sleep for another perceived 40 hours (really it was only 7 total) and awoke to feel a deep disconnection with the past as if I had taken a vacation and returned to my life in disorientation. This was the beginning of my experience with this strange drug.

I recently created a song that depicts the dysphoric dream space that is inspired by the game Little Nightmares 2. The song is called Screaming Echoes (The Transmission). The cover image is a shot of a datura plant near my house, even more fitting. This may help set the mood!

As the years passed, things only got weirder and I absolutely loved this. During this time period, my household life was in shambles. My mother was an alcoholic. There was violence. This drug allowed me to live within the virtual reality of my dreamscapes. I began to spend more and more time in such imaginary realms. At some point, I even began to lose track of what was real and what was daydreamed. I would interact with people in real life about experiences that occurred in my mind and they would correct me that the event or conversation never took place. Since my life was in such a chaotic place, this sort of thing didn’t bother me but instead fascinated me. Some days I would even consume Remeron during the daytime and sleep for almost 18 hours just lucid dreaming. I only tried that a few times.

The drug made real-life feel more distant like a hazy dream and made my imagination feel much more vivid as if it were real. My inner monologue became as loud as auditory perception. Sometimes this occurred with mental imagery as well. The most desirable effect for me was daydreaming in a way that I forgot that it wasn’t real. It was as if dreams and reality were pressed up against each other, both meeting at the bare minimum threshold for the sense of reality, competing against each other. And sometimes they really did crossover in the form of hallucinations. It was as if I was trapped in perpetual hypnogogia. I would hallucinate spiders, conversations with people, floating books, music, changes in the lighting of the room, and more. This seems to resemble the effects of deliriant drugs, although I’m not sure that Remeron could be perfectly described as a deliriant.

I have records of restarting my Remeron prescription from 2014. These notes may actually be from an earlier date, as it appears they have been transferred from a previous note-taking application. Some of these notes detailed an experience of forgetting where I am when I closed my eyes.

During the night I had many incidences of dreaming while awake and forgetting where I was. This was a common effect I’ve had often in the past. In specific, I had a moment last night while I was on the toilet and I closed my eyes only momentarily and began to dream, forgetting where I was. When I opened my eyes I was shocked to see I was still in the bathroom.

Dreaming awake in embaressing locations.

Besides forgetting that I was in the restroom, I’ve also forgotten I was in class. Another time, I was at home and believed I was in class. Sometimes I would even start conversing with my imagination, which would then form memories that I would accidentally believe are real. Upon hearing my voice speak, I would become shocked by the sound of it and hurled into awareness of my surroundings. Other times, I did not speak at all, except in my imagination.

Ultra-Vivid Dreams

There is some (but not a lot) research backing the strange dream effects of mirtazapine. One case study observed an individual on Remeron who awoken from vivid nightmares and could not unconvince himself of their reality for three days (Felthous, Wenger, & Hoevet, 2010). After recovering from his psychosis, Remeron was continued and vivid dreaming ensued. Another case report detailed the Remeron-induced nightmares of a young male. This person reported dreams of being stabbed, of their girlfriend being crushed under a collapsing building, and disturbingly, being cremated alive (Dang, Garg, & Rataboli, 2009). In that case study, the authors mention that Remeron actually increases REM sleep, unlike most other antidepressants (Schittecatte et al., 2002), which Dang, Garg, and Rataboli argue may underlie such nightmare induction effects.

This is actually opposed to deliriant drugs like scopolamine and (maybe) diphenhydramine, which both seem to suppress REM sleep (Sagales, Erill, & Domino, 1969; Gillen et al., 1991). In the case of diphenhydramine, it is less clear because there is a human study suggesting an increase of REM (Yangzom et al., 2015), but it is in burn victims, who seem to be struggling to sleep due to their pain according to the author’s data. This suggests that diphenhydramine is merely increasing total sleep and thus also REM in the case of these burn victims. In animal research, diphenhydramine decreases REM in multiple species (Saitou et al. 1999; Unno et al., 2012). I suspect that the REM enhancing effects of Remeron, along with its’ seemingly nonexistant anticholinergic effects, may set the drug apart from classical deliriants. Most of the effects of Remeron may be due to induction of hypnogogia, sleep paralysis, nightmares, and vivid and lucid dreams.

In my own experience, only about 20% of these Remeron dreams were nightmares. Many of these dreams brought on a state of awe and had a mix of cosmic horror and beauty to them. One of my favorite dreams involved driving some futuristic floating vehicle across some kind of cyberpunk dystopia. The buildings of the city were sepia-colored and were almost made of garbage. The ground was dirt and the sky was cloudy and had a sunset yellow and brown color. As I sped away from the cityscape and into the desert, there were these strange cardboard cutouts to my right. While I passed, it was like watching some kind of flipbook. They started as pictures of some deformed baby and by the end of the repeating iterations, this baby had transformed into an elderly man and became increasingly deformed until he died.

One of these experiences involved waking into a state of sleep paralysis and hallucinating my dead mother approaching me while I fail to scream for help. Below is the diary entry of this experience.

I was laying in bed trying to sleep and then I noticed it was extremely bright and colorful as if it were day but I knew it wasn’t. My bed was repositioned but I didn’t notice this as strange but it was on the north wall against the west corner. I saw blue, orange, and other colors of light on the walls and ceiling. When I realized that this was abnormal I saw movement in my grandma’s room. Someone got out of the bed. I was terrified beyond belief and felt my pulse grow strong. It became apparent that it was my deceased mom and she was quickly at the doorway. I began to scream as I knew this must be a hallucination. Then suddenly I could see my bed from its correct position and it was indeed dark. I screamed but I was far too paralyzed still. My grandma came by my side to help and wake me and I struggled to move my body. I felt shakiness and warmth throughout. My grandma grabbed my arm to wake me and I starting coming to my senses. Then I realized my grandma was not actually there but instead it was a hand without a body. The hand quickly vanished as I woke up and I was left terrified after this experience.

An account of hallucinating my mother.

This effect on dreaming seemed to extend to the waking hours. Often times I was lost in daydreams that were hyperrealistic and sometimes even indistinguishable from reality. One effect that occurred frequently was false awakenings. I would wake up and proceed to go about my daily routine and then blink to find myself still looking at the ceiling. This would often occur in loops as if I couldn’t escape the dream world.

I’ve also experienced something similar to the case study involving the individual who had persistance of their nightmare after waking.

I have just woken from a strange nightmare involving ghosts at my grandma’s house. After waking I have what I would believe paranoid psychosis is like: extreme fear of the unknown, illogical thoughts, confusion and hallucinations. Right now I am afraid of the dark, something I rarely experience. I saw something like a baby face. I heard rustling in my living room. I saw random textures morphing and changing. Everything is highly distorted. It is also hard to control my movement as well. I must have forced myself out of rem sleep. I think I will try to meditate into lucid dreams right now, although this is probably stupid and risky because of my lingering nightmare. The effects mostly faded now though anyways.

Nightmares crossover into reality, 2014.

Frequently, the dreams involved me being aware that I am in a dream, often referred to as lucid dreaming. This seemed to actually reduce the fear of some horrifying nightmarish scenery.

There was a nuclear explosion on the horizon that looked like the sun, birds in the sky disintegrated. Everything was red. This happened when I was driving my brother and sister home. We stopped at a park to see the amazing view. The bird that was flying quickly became a red glowing outline before it fell apart. You could see the star or nuclear explosion with such detail. You could also see the moon having and orange and red tint to it. It beauty ended when I realized planes were flying above dropping more of these bombs. The strangest thing is that before this happened, I was taking my siblings home because I needed to wake up. I didn’t feel fear when I saw the star/explosion. I knew I had to wake up. Instead of horror, I was in awe at the visually stunning scene that was in the dream.

Dreaming of dreaming and nuclear explosions.

Other dreams were very bizarre in their themes.

I’m this little character that no one seems to see. Some people can see me but not many. I hear strange voices. I keep spawning at the top story of this somewhat familiar house. It’s two story. Everytime I went down the stairs I left behind this older female ghost of me. She was slow, goth, and tall. There was this angel decoration on the wall and I walked by it and the ghost behind me went to tilt it. We giggled.

The dream repeated over and over and got more intense and changed subtly each time. I’m pretty sure I was a ghost. There were eerie noises the whole time. I felt a burning sensation throughout my body. The closer I was to the taller me, the more burning I felt. It also felt as if I was trying to escape hell but I’m pretty sure I was a demon in the world. I also remember battling with creature things and I had psychic abilities.

Escaping hell.

I dreamt of this unhappy giant person. Screaming and flailing. It said bus on the window which I realized read sub backwards meaning we must submerge to reach happiness as it was a parallel to this world.

Bus Sub, 2014

One of the rarer but more interesting kinds of dreams involved dreaming of dreaming and falsely waking up from what felt like years lived inside a dream.

There were layers of the dream. In the deepest layer I believed that I had time traveled to the 50s or 60s as part of a case study and experiment. I grew up for many years in this other place. I distinctly remember meeting people and becoming friends with multiple people. As time went on, the timeline began to speed up as I reached closer to the current day. Things also began to get distorted. I saw people from both time lines interacting. Then, it felt as if I woke up into real life. After this false awakening, I began telling people about my time-travel stories. Even in this layer, I remember many casual conversations about music and things taking place.

Multi-layered dreams and false awakenings, 2015

Perceptual Effects

Besides effects on dreaming, synesthesia also occurred on Remeron. While listening to music, there would sometimes be colored neon lights that matched with the sounds I was hearing in the songs. I also noticed I would often enter a trance in which the vocals of the song were no longer detectable but the rest of the music remained. This led me to wonder if our brain filters out human speech during sleep as an evolved tool for sleeping in the case of living in communities.

Another strange effect of Remeron is illusory palinopsia (Ihde-Scholl & Jefferson, 2001). This effect involves seeing images persist despite no stimuli being present. This often looks like visual trails and sometimes manifests as seeing images with your eyes closed. Other strange lighting effects occurred as well. Sometimes the lighting would start to change its’ levels every second or so. It would look like a sudden shift in brightness and then back to darkness and so on. This was often how I could tell it was beginning to take effect.

I found more notes from 2014 that depict such visual alterations.

Everything looks like I’m in a dream. Has a sort of crisp clear dark look with high contrast but more dark than brights. Seems to really highlight the brights with this effect though. Things seem clear but also things look very unfamiliar. Maybe it improves vision of color. In the darker areas of my room it mostly appears missing or fully black. My vision of dark seems poor. I believe it is related to some kind of enhanced contrast effect. I also notice more variations of color in each thing. And after images linger much longer and build-up faster. Pretty much every time I look at a visual scene I carry ghosting images when I move my eyes elsewhere.

Describing the visual alterations induced by Remeron.

Besides these effects, there were other less subjectively interesting effects. Remeron produced an extreme ‘munchies’ effect, surpassing cannabis by quite a bit. There were times where the drug seemed to induce body chills similar to being sick. The most intense effects sometimes involved waking up in the middle of the night with inescapable looping imaginations that seemed to make me intensely nauseas. This was exceedingly rare. Sometimes I woke up shivering but in a weird way that made me suspect it was a very minor seizure. This was also extremely rare and only lasted about 2 minutes and didn’t seem to pose any issue otherwise. I’m sure these sort of effects depend on individual sensitivities as well.

I found one account of a strange occurrence involving psychedelic-like visual illusions and bodily shaking.

I did not eat as I usually do before sleeping and I had strange hallucinations of breathing and drifting walls as I fell asleep. I shook intensely when this episode happened and it faded quickly. Possibly seizing? It happens often and is no problem but only occurs as I drift upon sleep. This sleep feels stimulated but deep somehow. I may have been in REM sooner than expected, possibly an hour in, as I woke up from extremely vivid dreams at this time. Usually REM starts 90 minutes into sleep.

Possible mini-seizure? 2014

Mechanisms

Let’s look at some mechanisms now. I saved this for the end because it might be less interesting to some. For others, this is where the real party begins. I won’t be going into every mechanism of this drug, but I will attempt to cover some of them that may explain some of these effects described above.

Remeron antagonizes or inverse agonizes the following serotonin receptors: potently at 5HT2a, 5HT2c, and 5HT3 and weakly at various other receptor serotonin types (Anttila & Leinonen, 2001; Van der Mey et al., 2006). Since serotonergic drugs generally seem to suppress REM sleep (Ursin, 2002), it could be that Remeron’s antiserotonergic mechanisms are mediating such REM enhancement. Though, the relationship between serotonin and REM sleep seems less straightforward. It seems certain serotonin receptor activity in specific brain regions may increase REM sleep too. The selective serotonin 1a receptor agonist 8-OH-DPAT increases REM sleep when perfused into the dorsal raphe nucleus, but when administered systemically it reduces REM sleep (Ursin, 2002). Ursin also mentions that the application of SSRIs, 5-HTP, or L-tryptophan decreases REM sleep. Ursin suggests that the 5HT1a autoreceptor agonism actually suppresses serotonin activity that would normally inhibit REM sleep.

Since posting this, a friend, Adam Karlovsky, brought to my attention that 5-HTP can actually increase REM sleep (Meloni et al., 2021; Wyatt et al., 1971). The authors of the Meloni paper argue that this may be due to increasing melatonin activity, which is a consequence of the increased serotonin. Whether 5-HTP promotes or inhibits REM sleep may depend on whether serotonin or melatonin conversion is high, which could be based on the timing of the dose. Melatonin itself has been reported to increase REM sleep (Kunz et al., 2004). Most fascinatingly, Remeron seems to increase melatonin as well (Palazidou et al., 1989). My current hypothesis is that this is due to the increased serotonin activity that occurs from Remeron’s alpha 2 adrenergic receptor antagonism (Davis & Wilde, 1996). The combination of serotonin receptor blockade and increased serotonin release may result in increased melatonin synthesis and activity without increased serotonin receptor agonism (except at 5H1a receptors), which could partly underlie the increased REM sleep induced by Remeron.

Since many sedatives seem to suppress REM sleep, including benzodiazepines, cannabis, and z-drugs (Pagel & Parnes, 2001; Babson, Sottile, & Morabito, 2017; Langtry & Benfield, 1990), Remeron may be somewhat unique in that it produces REM enhancement. This REM enhancement may even set it apart from other classical deliriant and hypnotic hallucinogens that are thought to work via anticholinergic or GABA mechanisms. Remeron is also said to have almost no anticholinergic mechanisms (Anttila & Leinonen, 2001). I’d be curious if its’ potent antihistamine effects (Anttila & Leinonen, 2001) could be responsible for some of these deliriant-like effects. Remeron fascinates me with its unique potential as a dream drug.

The palinopsia is reported to occur with at least 3 other drugs that share mechanisms with Remeron. Risperidone, trazodone, and nefazodone have been reported to induce the palinopsia (Lauterbach, Abdelhamid, & Annandale, 2000; Hughes & Lessell, 1990; Faber & Benzick, 2000) and also block or inverse agonize 5HT2a receptors (Lauterbach, Abdelhamid, & Annandale, 2000; Stahl, 2009; Cusack, Nelson, & Richelson, 1994). This seems significant because this receptor is the main target for psychedelic drugs, though in the opposite direction (agonism) (Moreno et al., 2011). This had me wondering if the residual perceptual effects that some report after psychedelic usage come from downregulation of this receptor, which these drugs like mirtazapine may mimic. It is important to note that the case report of risperidone-induced palinopsia mentioned the possibility that trazodone was involved in these effects.

Strangely, Remeron seems to partially agonize kappa opioid receptors (KORs), although it is said to not do so at clinically relevant doses (Olianas, Dedoni, & Onali, 2012). KOR is the main target of the dysdelic hallucinogen salvia divinorum. I wonder if this KOR activity could be amplified by Remeron’s action at 5HT2a receptors since it has been found that ketanserin, a selective 5HT2a receptor antagonist, is able to potentiate the KOR agonism related effects of morphine (Peiró et al., 2011). It isn’t so clear if this would be possible within Remeron’s mechanism profile. My intuition is that this is unlikely, but it would be highly interesting if true. Regardless of Remeron’s direct effects on KOR, it may also amplify the endogenous KOR activity of dynorphin.

Remeron also has potent adrenergic mechanisms, which could be implicated in REM sleep enhancement. The drug antagonizes alpha 2a, 2b and 2c adrenoceptors (Van der Mey et al., 2006). Alpha receptor antagonism has been shown to increase REM sleep (Oswald et al., 1975), though the drug used seems to mostly target alpha 1a receptors and may not share mechanisms with Remeron much. Drugs with similar adrenergic mechanisms as Remeron actually decreased REM sleep (Nicholson & Pascoe, 1991). It isn’t clear that adrenergic mechanisms play a role in these REM enhancing effects of Remeron, although if you think otherwise please comment and let me know.

I am considering trying to dose Remeron and examine EEG readings both before the dose and after, to compare, especially during hallucination. I could compare the EEG of REM and Remeron and possibly other sleep states and see if there are any interesting patterns. Let me know if this interests you.

. . .

If you found this enjoyable, consider joining the Patreon! I’ve been posting detailed experience reports with my adventures using prescription ketamine. Also. someone sent me an EEG device to collect data on ketamine-induced brainwave changes which I’ve started posting there too. I also post secret mini podcasts. You can find the publicly available podcasts here by the way!

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References

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2 thoughts on “Remeron: The Dream Drug

  1. This reminds me a lot of the fictional drug in the Netflix special, Maniac, starring Emma Stone and Jonah Hill. I highly recommend giving that a watch if you haven’t already.

    Liked by 1 person

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