# fluoxetine+fluanxol



## broflovski (Feb 1, 2011)

I've been taking fluoxetine for more than 3 months already, and it has really improved the quality of my life very much. The most crucial thing for not to develop tolerance and to enhance and correct its effect is adjunction with something like yohimbine or bromantane. There is some evidence  that augmentation of SSRI with some low-dose antipsychotic is beneficial. In doses below 3 mg (directly indicated according to information sheet for 'asthenic' type of depression, anhedonia, dysthimia and lack of initiative) fluanxol is dopaminergic in a low-dose amisulpiride like manner


> its antidepressant effects at lower doses may be mediated by preferential D2/D3 autoreceptor blockade, resulting in increased postsynaptic activation


 It additionally blocks 5HT2a receptors (with more affinity than fluoxetine itself). It is also known that synergy of SSRI and antypsichotics inspired Elly Lilly to develop a two-in-one combo Symbyax 


> Symbyax increases extracellular serotonin due to its fluoxetine component. However, Symbyax also causes an increase in dopamine and norepinephrine; this increase is believed to be the result of a synergistic effect between fluoxetine and olanzapine. Preclinical trials reported a 232% increase in dopamine (compared to a 66% increase with just olanzapine or a 55% increase with just fluoxetine) and a 160% increase in norepinephrine (compared to an 89% increase with just fluoxetine or a 33% increase with just olanzapine).


I have no Zyprexa in disposal, but I managed to obtain fluanxol, and begin to take 1-2 mg of it daily along with my daily 10-20 mg fluoxetine.


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## upndownboi (Oct 7, 2010)

I had to look asthenic up, i'd never heard the term before, perhaps its more commonly used in siberia. i don't really know much about fluanxol but it would be interesting to hear your results of the prozac/fluanxol combo.

Has your previous experience with coaxil made you a convert to the church of dopamine?  I don't mean to make fun - as you know I have a fervour for prozac.

sorry I couldn't be of more help, i don't know whats available in you area and what you can access but if you're prepared to look past dopamine perhaps lamictal might be worth a shot. is there any chance of an maoi being accessible? also natrexone is supposed to mediate some dopamine pathways and I've heard of it being used successfully with fluoxetine, even causing hypomania (but only if ur lucky).


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## broflovski (Feb 1, 2011)

Oh, I thought 'asthenic' is more commonly used(( my English is too bookish...
My aim was to substitute yohimbine with something for a time, to beat possible tolerance... and check that promising D-autoreceptors blockade hypothisis, that has inspired me for a long time. I managed to obtain that antipsychotic without prescription, but it appeared to be slightly sedating, because of antihistamine effect. My results may currently be masked with my routine kratom binge. And yes, I'm very much focused on dopamine, cause it lets us to feel good to be alive
Don't understand much about lamictal and dopamine, according to Wiki it is something more related to pregabaline (though another kind of ion channels is inhibited). I need something more directly dopaminergic than naltrexone. What about short-term opioid blockade? i enjoy opioidergic effects, even indirect, like with tianeptine. Actually i'm currently in an afterglow state, after yesterday's party on kratom, that induced such a love for everyone in the club, and made (evenly) uninteresting party sooo good. 
Never considered MAOIs, including so widely discussed Nardil.... I think it may be difficult to maintain a diet, in my circumstances... but i'm impressed with theory behind Selegiline, MAO-B selective (dopamine again!).


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## upndownboi (Oct 7, 2010)

http://www.dr-bob.org/babble/neuro/20090701/msgs/904542.html

you may have already seen it


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## csrpj (Feb 24, 2010)

the article talks about low-dose fluoxetine being dopaminergic. is it not dopaminergic at higher doses too?


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## broflovski (Feb 1, 2011)

It is discussed whether fluoxetine is effectively dopaminergic in low doses. It is in high-dose ingestion, then it appeared to be obviously dopaminergic. 


> The Ely Lilly scientists also suggested that the effects on dopamine and norepinephrine may contribute to the antidepressant action of fluoxetine. In opinion of other researchers, however, the magnitude of this effect is unclear. The dopamine and norepinephrine increase was not observed at a smaller, more clinically relevant dose of fluoxetine. Similarly, in electrophysiological studies only larger and not smaller doses of fluoxetine changed the activity of rat's norepinephrinergic neurons. Some authors, however, argue that these findings may still have clinical relevance for the treatment of severe illness with supratherapeutic doses (60-80 mg) of fluoxetine.


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## crayzyMed (Nov 2, 2006)

I tried amisulpiride for a bit but my dick turned grandpa power barely any force and power in it.


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## broflovski (Feb 1, 2011)

Ha, ^^ this is not of so much importance for me, but I'm a bit disappointed with the combo, and I remember that your skepticism and warnings about antipsychotics... My current focus is on fluoxetine + bupropion combination, that is reported to be pretty synergistic. And I need something to give up smoking (I quited last autumn with cytisine, but now have a relapse, because of some external circumstances). Cytisine is reported to be antidepressant on its own and again synergistic with prozac.


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## broflovski (Feb 1, 2011)

upndownboi said:


> http://www.dr-bob.org/babble/neuro/20090701/msgs/904542.html
> 
> you may have already seen it


Nice post, confirming the things I take into account when designing my cocktails. Low-dose fluoxetine dopaminergic action is still under question though.


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## upndownboi (Oct 7, 2010)

broflovski said:


> Ha, ^^ this is not of so much importance for me, but I'm a bit disappointed with the combo, and I remember that your skepticism and warnings about antipsychotics... My current focus is on fluoxetine + bupropion combination, that is reported to be pretty synergistic. And I need something to give up smoking (I quited last autumn with cytisine, but now have a relapse, because of some external circumstances). Cytisine is reported to be antidepressant on its own and again synergistic with prozac.


i see you sometimes take a med for anxiety - i would start very slowly on bupropion, its my experience that its stimulation is of a different nature and magnitude to the rather mild and pleasant 5ht2c type.

regarding your wish to stop smoking, apparantly tobacco smoke is a mild maoi, and nicotine cuts the brakes on dopamine. nicotine gum may therefore be useful along with something like rhodiola rosea as the replacement mild maoi.


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## broflovski (Feb 1, 2011)

I remember you reported tension and sleep problems with bupropion, but I'm going to combine it with fluoxetine for synergy, and that is more essential in this context - with afobazole and phenibut PRN for anxiolysis. And I'll start slowly, 1*150 mg daily, and I'm not even going to increase the dosage after 7th day as it is recommended in anti-smoking course (and will save more staff!). Though it depends on what I'll feel. And I take rhodiola as a day starter just before my morning exercises, it is nice. It is said to be useful in many ways.



> Rhodiola has been speculated to have the following mechanisms of action:
> 
> 
> Prolyl endopeptidase inhibition (increasing various substances, including oxytocin)
> ...


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## broflovski (Feb 1, 2011)

Update: that fluanxol seems to start working. I wake up at 6 a.m. full of drive and self-confidence. Mild antihistamine effect is counteracted with caffeine efficiently. And I take only 1/2 1 mg tab * 2 daily (totally 1 mg) now.


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## Jimminy_Billy_Bob (Nov 26, 2008)

I really want to try prozac, never really considered it after trying celexa and a couple of other ssri's with no results. I think maybe prozac plus zyprexa might be a good combo.


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## upndownboi (Oct 7, 2010)

broflovski said:


> Update: that fluanxol seems to start working. I wake up at 6 a.m. full of drive and self-confidence. Mild antihistamine effect is counteracted with caffeine efficiently. And I take only 1/2 1 mg tab * 2 daily (totally 1 mg) now.


good news, glad its starting to work, qualitively how does it compare to regular fluoxetine+yohimbine? also, were there any signs that tolerance was starting to build to yohimbine? keep us updated


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## broflovski (Feb 1, 2011)

Fluoxetine+yohimbine was all right, as for tolerance to yohimbine, it's manifested more when using 'for special occcasions' _along with _ regular usage. But I have a zest for innovation


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## upndownboi (Oct 7, 2010)

this thread has interested me in trying ld flupentixol, although certain of the side effects concern me, although i guess i won't know the risk/benefit until i try it. Anyway I will await ur conclusions. In the meantime my pdoc has recommended I persist with the bupropion augmentation, increasing dose very gradually but if I still can't tolerate it he said we could swap it out for an anti-psychotic, he mentioned abilify, but I might suggest ld flupentixol or olanzazpine. also, I may suggest amantadine as an alternative DA releaser to him. this is all on the basis of using fluoxetine as the ssri (as i dislike the pro-attenuation effects of typical ssris/snris- effexor being a culprit) so ne function would also need to be maintained, this brings me round again to hoping the bupropion will end up suiting me, as otherwise i'd be looking at something like yohimbine.


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## endorphinist (May 7, 2011)

I am truly glad it's working for you!
But do you exercise regularly? I'm just saying because idk if you plan on being on the antidepressants all your life? So maybe one of these days when your stable with everything in your life you can slowly taper down? Because I heard the withdrawals are a *****


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## broflovski (Feb 1, 2011)

to upndownboi:
I'd better try amisulpiride than fluanxol as antipsychotic augmentation, because of its additional GHB-agonism and 5HT7 antagonism but it's not available here.
to endorphinist:
it's my persistant background concern... but currently i see no problem in staying on meds for long. it's not much harmful as, say, social drinking or taking a beer each evening as many ppl do etc... and much less harmful than life-long pain maintainance with opioids (that may still be necessary for some ppl and not ruining). my quality of life has improved tremendously with meds. 
but maybe this are meds that make me think too positive, and i'm mistaken.


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## upndownboi (Oct 7, 2010)

broflovski said:


> to upndownboi:
> I'd better try amisulpiride than fluanxol as antipsychotic augmentation, because of its additional GHB-agonism and 5HT7 antagonism but it's not available here.


 thanks for your suggestion, i will look into it... (AMISULRPIDE)
somethings i found out about it:

-antidepressant effect via 5ht7 as you kindly mentioned
-some report quite profound and rapid improvements, especially from dysthmia
-can cause low prolactin, as experienced by crayzmed 
-some describe it as 'feels anti-dopaminergic even at low doses', likely subjective experience tho
-seems more talented than other low dose APs at causing EPS

you sound to have come across a combo which really suits you (fluoxetine+fluanxol) so i realise the 'whys' and 'hows' probably don't feel as important now but I have a question, if you'd be good enough to offer your opinion?:



broflovski said:


> It is discussed whether fluoxetine is effectively dopaminergic in low doses. It is in high-dose ingestion, then it appeared to be obviously dopaminergic.


does this mean fluoxetine's 5ht2c dopamine dis-inhibition is still present at higher doses like 40mg+? (i always thought it was more present at lower doses?). i ask because if 40mg+ of fluoxetine is still enough dopaminergic, then fluoxetine+bupropion seems _very_ appealing; you could use the fluoxetine to maxmise dopamine-to-noradrenaline ratio of bupropion _and yet still _take advantage of fluoxetine's 5ht2c antagonism - win, win


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## broflovski (Feb 1, 2011)

^^ according to Wiki (and the researches to which it refers) doses, causing DA increase were relatively high, but still achievable in humans as 'supratherapeutic'. at the same time ppl in discussion on Mind and Muscle, (that seems relyable) conclude that low doses also work, cause even slight occupation of 5HT2c receptors is enough for functional responce (in contrast to SERT occupation, that needs to be high). 
Anyway, the higher the dose, the stronger the action, isn't it? 5HT2c antagonism is not nearly diminished, but only subjectively masked with SRI action in higher doses. 
And that pharmacokintic idea with bupropion is really nice. That's why I'm looking forward to my bupropion order very much. And I'm sick of smoking!
And one more idea: bupropion is known to inhibit uptake, but decrease the release of DA (due d-autoreceptors inhibitory mechanism, as goes with SSRI and 5HT1a autoreceptors initially), so fluanxol with its presynaptic D-antagonism should prevent it!


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## upndownboi (Oct 7, 2010)

broflovski said:


> And one more idea: bupropion is known to inhibit uptake, but decrease the release of DA (due d-autoreceptors inhibitory mechanism, as goes with SSRI and 5HT1a autoreceptors initially), so fluanxol with its presynaptic D-antagonism should prevent it!


very nice  if ever there was a reason to add low-dose AP to unsatisfactory bupropion treatment (specifically increased 'spaced out' feeling) i think that might just be it. what do you think of abilify/aripiprazole? my pdoc suggested that as a replacement for bupropion, it seems to partially activate d2 receptors instead of antagonising them.

also, how about ephedrine as a substitute for yohimbine in your regimen?


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## broflovski (Feb 1, 2011)

I've been using ephedra PRN for a long time, I gave it up, because of severe hangovers. Its noradrenergic and slight dopaminergic action differs very much from that of yohimbine, and it has no serotoninergic synergy with fluoxetine at all in contrast to yohimbine (or mirtazapine in the same manner). Yohimbine with its 5HT1a partial agonism etc fits much better.


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## broflovski (Feb 1, 2011)

Ok, that combo with fluanxol is really synergistic in respect of mood, but it worsen my ADHD symptoms and cause some restlessness and inner tension. The remainder of the drug I'll consume at the lowest dose 1 mg/daily.
I'm shifting now to bupropion as the main augmentation to my low dose daily fluoxetine. Above mentioned dopaminergic synergy via 5HT2c/2a and pharmacokinetic interactions + success in smoking cessation are to be checked. I'll try to control possible anxiety with indirectly GABA-ergic afobazole and phenibut PRN. 

Update: I feel mood lift from the very first dose (placebo?) some good signs in nicotine cravings and definite improvement in concentration (I've managed to read that boring article on artificial intellect in English).


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## upndownboi (Oct 7, 2010)

broflovski said:


> Ok, that combo with fluanxol is really synergistic in respect of mood, but it worsen my ADHD symptoms and cause some restlessness and inner tension. The remainder of the drug I'll consume at the lowest dose 1 mg/daily.
> I'm shifting now to bupropion as the main augmentation to my low dose daily fluoxetine. Above mentioned dopaminergic synergy via 5HT2c/2a and pharmacokinetic interactions + success in smoking cessation are to be checked. I'll try to control possible anxiety with indirectly GABA-ergic afobazole and phenibut PRN.
> 
> Update: I feel mood lift from the very first dose (placebo?) some good signs in nicotine cravings and definite improvement in concentration (I've managed to read that boring article on artificial intellect in English).


zyban's a good aphrodisiac too, if you can handle the side effects.

has anyone ever tried fluoxetine with tegretol? tempting but tegretol scares me. this dr says he gets good results with it for bpd.


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