# So majorly depressed; I need help making a decision.



## gilmourr (Nov 17, 2011)

So right now I'm inbetween psychiatrists so I'm kind of unsupervised atm.

I'm on Zoloft 75 mg, Gabapentin 300 mg/daily and Wellbutrin XL 150 mg.

3 days ago my mood plumetted drastically, which I attribute to one of a few scenarios.

1. Whatever effect Nardil had is gone now and I'm just transitioning and waiting for Zoloft to kick in. This is just my underlying major depression and I should keep waiting with this combo.

2. Wellbutrin XL is NE and DA based. Meds that are NE based or NET inhibition based usually cause severe mood swings or depression. Cymbalta did, Nardil, Parnate did as well. I should remove Wellbutrin XL

3. Wellbutrin XL is inducing the depression but I should wait through it. It's just a side effect and it'll get better.

4. Gabapentin is causing a worsening of depression and I should stop it.

** It's not Zoloft because I've been on it countless times. I'm basically at a crossroads between whether this is my inherent major depression coming out since I just started up meds... Zoloft (14 days in), wellbutrin and gabapentin (7 days in), or whether this is being caused by a med.


Leave your opinion. I understand that anything taken from this forum should be consulted with a doctor.

IMO I think it's the wellbutrin XL, though it might just as easily be my major depression since zoloft takes 3.5-4 weeks to kick in...

Thank you for any replies/help in advance, I feel like utter ****. Fml.


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## riptide991 (Feb 1, 2012)

I'm not very versed in Gabapentin but I read reports of others having depression as a result of it and depression is a side effect of the med.



> http://www.painsupport.co.uk/connect/dfviewreplies.asp?topic=6054
> 
> *Di - Lancashire*27 Nov 2010​
> I was put on Gabapentin years ago. It caused severe depression so I came off it. I reduced it in exactly the same manner I had increased it, a small amount each week or two weeks and I had no withdrawal symptoms at all. My mood lifted with each reduction and by the time I was off it I was back to my normal self. I had been taking oxycodone at the same time and discovered the gabapentin hadn't been giving me any pain relief at all.


Anyways, you can remove the wellbutrin if you think that's the culprit and see if your mood lifts. Wellbutrin doesn't sit around in your blood for too long so should be gone within 4 days or so. Then if that doesn't do it remove the gabapentin and see if that helps.

http://blogs.wsj.com/health/2008/06/20/early-neurontin-link-to-depression-was-ignored/


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## gilmourr (Nov 17, 2011)

kehcorpz said:


> I'm not very versed in Gabapentin but I read reports of others having depression as a result of it and depression is a side effect of the med.
> 
> Anyways, you can remove the wellbutrin if you think that's the culprit and see if your mood lifts. Wellbutrin doesn't sit around in your blood for too long so should be gone within 4 days or so. Then if that doesn't do it remove the gabapentin and see if that helps.
> 
> http://blogs.wsj.com/health/2008/06/20/early-neurontin-link-to-depression-was-ignored/


Yeah, I'm thinking about removing gabapentin first just because it gets out of your system and starts working fairly quickly right? If I were to remove wellbutrin and was wrong then I'll need to restart it which in that case will take much longer to start working--reuptake mechanisms always seem to take like 4-8 weeks.

I'll see what others think, but gabapentin makes more sense personally to me. Mainly because it wastes less time if I'm wrong


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## Jawi96 (May 15, 2012)

So, Racetams.. Here's a thing http://www.socialanxietysupport.com/forum/f30/piracetam-log-wow-176871/

Yea, I'm sure that results can vary drastically, but it's still super cool reading this. Also, the guy never even tried any Noopept or Noopept stacks.

On piracetam, I even thought that my Nardil kicked in prematurely but was a bit weak because of the mood lift it gave me. That, plus if my Nardil actually DID kick in probably would have been incredible. I also had WAY better hand eye coordination, I went from being able to bounce a badminton shuttlecock 2-3 times to over 20.


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## CD700 (Apr 22, 2010)

Jawi96 said:


> So, Racetams.. Here's a thing http://www.socialanxietysupport.com/forum/f30/piracetam-log-wow-176871/
> 
> Yea, I'm sure that results can vary drastically, but it's still super cool reading this. Also, the guy never even tried any Noopept or Noopept stacks.
> 
> On piracetam, I even thought that my Nardil kicked in prematurely but was a bit weak because of the mood lift it gave me. That, plus if my Nardil actually DID kick in probably would have been incredible. I also had WAY better hand eye coordination, I went from being able to bounce a badminton shuttlecock 2-3 times to over 20.


I really am disappointed with my Aniracetam that I got the other day. So so so disappointed. I'm not giving up on it completely though and will try a massive does before I walk to shops later.


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## Jawi96 (May 15, 2012)

CD700 said:


> I really am disappointed with my Aniracetam that I got the other day. So so so disappointed. I'm not giving up on it completely though and will try a massive does before I walk to shops later.


I've read Aniracetam's effects only lasts like 2 hours. I would rather not get into something that involves constant mood fluctuations on a daily basis unless I had enough money to shell out to take it every 2 hours every day, which I don't. Also, the effects of other racetams and different racetam stacks and different doses or whether or not you add choline can have you have a completely different response. I wouldn't give up on racetams entirely just because 1 or 2 things didn't work.


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## CD700 (Apr 22, 2010)

Jawi96 said:


> I've read Aniracetam's effects only lasts like 2 hours. I would rather not get into something that involves constant mood fluctuations on a daily basis unless I had enough money to shell out to take it every 2 hours every day, which I don't. Also, the effects of other racetams and different racetam stacks and different doses or whether or not you add choline can have you have a completely different response. I wouldn't give up on racetams entirely just because 1 or 2 things didn't work.


Yeah I take Choline and Inositol + fish oil
Piracetam is scheduled now I believe so cant get it no more
May try the others at some stage


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## Jawi96 (May 15, 2012)

CD700 said:


> Yeah I take Choline and Inositol + fish oil
> Piracetam is scheduled now I believe so cant get it no more
> May try the others at some stage


If you're taking the soft gels, you might want to switch to a powder of something like choline bitartrate or alpha GPC. that way it's easier to manipulate the dose as the capsules usually don't contain any less than 250mg. Also, try removing the choline. some people respond better without it and most of the time it's just helpful to people who megadose their racetams


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## basuraeuropea (Jul 25, 2012)

gabapentin may very well be the culprit and you're thinking of removing it to see if that indeed is the case, although if you've been taking the medication for a long period of time, taper!


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## gilmourr (Nov 17, 2011)

basuraeuropea said:


> gabapentin may very well be the culprit and you're thinking of removing it to see if that indeed is the case, although if you've been taking the medication for a long period of time, taper!


Been on it for a little more than a week. I think taking 1 pill for the next 3 days (100mg) and then 0 should be fine. I'm sure using nothing would work as well. 300 mg/daily is pretty low.


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## basuraeuropea (Jul 25, 2012)

gilmourr said:


> Been on it for a little more than a week. I think taking 1 pill for the next 3 days (100mg) and then 0 should be fine. I'm sure using nothing would work as well. 300 mg/daily is pretty low.


very low, indeed, and you haven't been taking it for long at all so you would likely be fine stopping it abruptly.

even low doses, though, taken over extended periods of time can cause really unpleasant withdrawal symptoms.


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## jim_morrison (Aug 17, 2008)

Night Cafe said:


> I had to go through this with my Adderall/Lexapro and it was not fun. Sometimes it's easier to just go through the torment, then a month or so later titrate either one up or down slightly to get the fogginess (from SSRI)/depression (from stimulant) see-saw worked out.


That is interesting, how do you find the Adderall/Lexapro combo now that it's stabilized?


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## gilmourr (Nov 17, 2011)

jameslp3230 said:


> I strongly recommend that you talk to your new doctor about Lamotrigine.
> 
> You should not be on Wellbutrin. Gabapentin although sometimes used as a mood stabilizer can actually be activating at times, and it is deceptively addictive in the long term. It's not scheduled in US but Pregabalin is, and they are very similar.
> 
> Also don't think that increasing Zoloft dose will make it better. 75 is really enough. You're always destabilized on NE/DA antidepressants as well as having little or partial response. It's almost certain that you would benefit from a depression side bipolar treatment, so Lamotrigine first. And I think if you want to do destabilizing ADs Lithium would be needed even if in low doses.


Well we'll see if Gabapentin was the issue, I removed it today. If I get through the weekend with no mood swings then I'm going to attribute the mood swings/depressive lows to gabapentin (but will test it out again to see if it's just my inherent major depression since it might be that).

I can't do Lamotrigine because I had an allergic reaction to it. I was thinking of trying Lamictal brand instead since it might be different with inactive ingredients that might be causing a reaction.

You didn't talk about depakote...any reason for that? I think depakote has less cognitive side effects than lithium. I also don't like the idea of being dehydrated and levels of lithium just reactively rising like that.


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## basuraeuropea (Jul 25, 2012)

gilmourr said:


> Well we'll see if Gabapentin was the issue, I removed it today. If I get through the weekend with no mood swings then I'm going to attribute the mood swings/depressive lows to gabapentin (but will test it out again to see if it's just my inherent major depression since it might be that).
> 
> I can't do Lamotrigine because I had an allergic reaction to it. I was thinking of trying Lamictal brand instead since it might be different with inactive ingredients that might be causing a reaction.
> 
> You didn't talk about depakote...any reason for that? I think depakote has less cognitive side effects than lithium. I also don't like the idea of being dehydrated and levels of lithium just reactively rising like that.


i actually think depakote has more cognitive side effects than lithium.


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## gilmourr (Nov 17, 2011)

jameslp3230 said:


> I know I said this before but if there is any way, shape or form you can get on Lamotrigine safely it would help you more than pretty much any drug out there. Some doctors know how to manage allergic reactions with acute and prophylactic antihistamines. It's worth persisting if at all possible. For better or worse with severe depression the lowest dose possible of an SSRI is the only thing you can do, so apart from that you need to look at other options and unfortunately give up increasing NE/DA. As a whole being preoccupied with 5HT/NE/DA is just subscribing to the theory of depression pharmaceutical companies have pushed for decades, but it's more complex than that. Fully effective treatments to heal the damage do not exist. But by broadening your scope you can try to find drug treatments that can at least patch up some of the effects of the underlying damage as best they can. Look at Glutamate more so than 5HT. Memantine has a good following. Also as far as agitation a-adrenergic antagonists like Quetiapine and to a greater extent Tizanidine help to indirectly suppress glutamate transmission, perhaps one of the reasons why increased NE e.g. from Nardil is so bad. Tizanidine is not typically used for agitation, it's a muscle relaxant/anti spasmodic but it knocks me for six. One of the ways I think Lithium works is suppressing NE somehow.
> 
> Well Valproate is good for decreasing agitation especially in mixed states as you are experiencing, but it's also known for removing the agitation while making the depression worse. Lithium can occasionally do that, but it's also used as an effective antidepressant either alone or as augmentation and can produce complete suppression of the manic pathway, very useful when antidepressants cause such manic symptoms (agitation). It is also very neurotrophic and can regenerate some of the 'shrivelled' parts of your brain. Valproate has some neurotrophic properties but it also has neurotoxic properties at the same time at normal doses.
> 
> I think it is far more likely that Wellbutrin combined with Zoloft is causing your mood swings. Gabapentin should improve your mood and if anything causes 'euphoric' swings but Zoloft and Wellbutrin will cause dysphoric agitation / mixed states. You're making your brain a lot worse being on Wellbutrin, however mainstream doctors are not aware of this danger and continue to prescribe these things for depressed bipolar spectrum patients.


Well Zoloft alone doesn't cause any mixed states, I'm just anhedonic and mildly-moderately anxious--which is why I added the wellbutrin XL.

Someone on another board said that if the depression becomes so bad that it's challenging your "worst ever depression" then come off the wellbutrin XL. But if it's major depression that isn't the worst you've experienced see if you can wait 6-8 weeks to see if it will level out. I think I'm going with this logic.

The closest to the bipolar spectrum is mixed state/agitated depression as I'm 99% certain I'm not BP1 or BP2. I've been on way too many stimulating meds and I've never been manic.

I'll talk to my new psych about being re-diagnosed.

Also, I really don't want to try Lamotrigine again though I'd try the brand. I don't think antihistamines will help open my throat up when it begins to happen.

Thanks for the input, I'll look at memantine. What about antipsychotics? Would you recommend an antipsychotic with Zoloft and wellbutrin or only with Zoloft?

EDIT: Plus, if when I'm on Zoloft I have anhedonia like symptoms, how can I use lithium? That would just make me majorly anhedonic most likely. It will suppress NE even further. Though maybe that's what I need. Maybe the release of NE is depressing for me while the blockade of NE is anti-depressing. First day I used gabapentin I had some nice euphoria and that basically slows the release of neurotransmitters through calcium channels.

I was thinking of using pregabalin since it has a different mechanism of converting I think glutamate or glutamic acid to GABA. Might be a good idea.


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## Ben12 (Jul 8, 2009)

Haven't read everything so forgive me. 

Gilmourr, what made you quit the nardil? It seemed like it was really helping you. Not 100% of course but certainly at least a bit.


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## Chris John (Jul 4, 2013)

*It's the Wellbutrin*

I agree with you that it's probably the Wellbutrin. I was only on Wellbutrin for a few days because I couldn't stand the effect it was having on me. Essentially made all my problems worse, especially the general anxiety. It may be an effective drug if taken for a while though.

My friend took gabapentin and said that in the beginning it made him feel a little drunk, but not depressed or anything like that. I doubt it's the gabapentin. And you said you doubt it's the Zoloft.

If I were you I'd just push through the pain right now (though I don't really know how much pain you're in). If it gets too bad, cut the Wellbutrin and start taking it again later when the Zoloft and gabapentin have taken effect.


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## CD700 (Apr 22, 2010)

I dunno how you guys write such long messages
We have different kinds of depression I guess hehe


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## gilmourr (Nov 17, 2011)

Yeah, I'll talk with my new psychiatrist on Tuesday about diagnosing mixed state/agitated depression and to see if I fit into it; I believe I do.

It makes sense because I have psychomotor agitation, family history (close) of bipolar disorder, I've had hypomania from Cymbalta and Parnate, maybe even Nardil? Wellbutrin hasn't done anything in that regard... though I think it's the least potent NRI if I'm correct.

What do you think about Abilify as a mood stabilizing medication? It's similar to remeron post synaptically (which basically destroyed all major depression) and it has 5HT1A partial agonism with D2 as well. Maybe just a higher dose so it hits those receptors.

Like I said, I'll probably retry Lamictal, but the brand this time since I tried the generic. I can spot the allergic reaction fairly well.


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## gilmourr (Nov 17, 2011)

Also, it seems like yesterday without gabapentin and wellbutrin XL with Zoloft was the worst day I've had in the last 2-3 weeks.

Mad insomnia even taking seroquel XR...finally clonazepam with seroquel got me to sleep.

I dosed up wellbutrin XL with Zoloft again today...we'll see if it's similar or worse.

BTW, james, what do you think about deep brain stimulation for agitated depression? I've been thinking about it more since I've been having a little bit less hope about medication getting me to a functional state.


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## gilmourr (Nov 17, 2011)

jameslp3230 said:


> Lamotrigine is worth another shot, starting really really low and notifying your doctor of previous allergic reactions so asking for a good bunch of antihistamines. Then again if you tell your docs about that they will probably sh*t themselves and refuse to prescribe it. :-/
> 
> For as needed agitation Seroquel and clonazepam is a good choice, also consider baclofen as it's not really that addictive and you can use it when you don't use a benzo to stop tolerance building. Baclofen rules I get bottles of it for 30 bucks, 100 x 10 mg.
> 
> ...


Thanks for the post; I read everything. What dose do you think would be good (lithium) for agitated depression as I'm not full bipolar (I definitely don't think I am).

Also, 3rd day into wellbutrin alone, 11th I think in total and I just feel like absolute ****. Tomorrow I think I'm going to stop it and maybe consider it when Zoloft levels out, or when I'm on zoloft and a mood stabilizer.


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## gilmourr (Nov 17, 2011)

Stopped Wellbutrin XL after 11 days, going to wait for Zoloft to level out, then may add it back to see if it really causes a mood drop. All I know is that in the morning/afternoon I feel like absolute **** after dosing and by the night I start feeling kind of hypo. 

Will talk about all of this with my psych... I'm probably going to add abilify on wednesday or something. It doesn't inhibit NET and it works post synaptically on receptors that are similar to remeron which was unbelievable for my depression.


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## markwalters2 (Mar 18, 2013)

Try St John's Wort. It works well for some people.


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## gilmourr (Nov 17, 2011)

Hush7 said:


> Been lurking in this thread and hoping Gilmourr would have a positive experience with Welloft. Was thinking about adding Wellbutrin to Zoloft too, but couldn't find many personal experience reviews since most people just say, "It works!" or "It didn't work!" Guess I'll either have to bite the bullet and try it or keep lurking in case Gilmourr adds it back again.


It actually wasn't at all bad side effect wise and it didn't make me feel anxious which I was surprised about. If it wasn't for the mood shifts/decline, I would continue taking it. Also, I've had many cases of mixed/worsened depression by NRI's so I think it was a good decision to stop it.

I feel less energetic of course since stopping wellbutrin, but I feel like my mood is level throughout the day and I don't feel that bad. I think for now it was a good choice to stop until more Zoloft is in my system or until I get a mood stabilizer.

Going to my psych today. Hoping to get pregabalin and abilify (doesn't really work presynaptically on NE, so it might be great). Also will talk about a difference between lamotrigine and lamictal if it exists, and about having mixed/agitated depression added to my file.

I'm a little conflicted to bring up the mixed agitated depression though because it might deny me to DBS if I actually do get to that point because of being on the bipolar spectrum. I know the study I was looking into is only MDD.


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## gilmourr (Nov 17, 2011)

So... went to my pdoc. Feel a bit rattled, probably the most rattled I've been leaving a pdoc's office ever. 

We talked about mixed states for a bit but she thought mainly that I'm a MDD rather than bipolar or mixed state. That's fine, although I wish she would've reached her conclusion in a more substantiated way.

She didn't prescribe me anything new as she just wanted to "absorb" me first. I guess that's fair, but I'd rather she read my chart before I came as I would've appreciated leaving with a new script rather than waiting on Zoloft still. 

I brought up pregabalin for the residual anxiety; She countered with 0.5 mg klonopin in the morning and at night. I know klonopin helps (doesn't do enough) but I don't like being on benzos daily... 

I brought up abilify for the residual depression and apathy/dysthymia; She countered with risperidone 0.5 mg I believe.

Honestly... I think risperidone was one of the last AAP's I was thinking of. I would've gone, Abilify, Zyprexa, Geodon in that order then risperidone. I think this is just going to make me feel brain dead.

Is risperidone not generic or something? I couldn't figure out why she liked it so much. 

I left with this feeling of wanting to go home and kill myself; I felt like I was handling my psychiatrist. This all feels ****ed. Maybe it's the fact that zoloft probably hasn't kicked in yet and I just had a ****ty day. But sometimes, **** all of this.

EDIT: BTW does risperidone cause EPS/TD at low doses? And if I notice it, it normally goes away right as long as you stop it quickly enough, right?


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## riptide991 (Feb 1, 2012)

I mean i'm no expert but it just doesn't seem like you're bipolar and norepinephrine is your problem. Keep in mind that there was a point when Nardil was your savior, and it has always had the same effect on norepinephrine. Unlikely your genetics changed between Nardil uses. But either way, if you are bi-polar get a second opinion from a doctor not someone on the internet. 

As far as the Risperidone goes, if you get TD then unlikely it will reverse even if you stop. But still the chances of getting this are very low even at schizophrenia level doses. 

Anyways, if you don't like norepinephrine this drug is for you no doubt. Give it a try for a bit and see how it goes. If you don't like it then you can at least tell your doctor you tried her suggestion and would like your own. I've read of some users on here using this drug maybe you can use the search to see their experiences.


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## gilmourr (Nov 17, 2011)

kehcorpz said:


> I mean i'm no expert but it just doesn't seem like you're bipolar and norepinephrine is your problem. Keep in mind that there was a point when Nardil was your savior, and it has always had the same effect on norepinephrine. Unlikely your genetics changed between Nardil uses. But either way, if you are bi-polar get a second opinion from a doctor not someone on the internet.
> 
> As far as the Risperidone goes, if you get TD then unlikely it will reverse even if you stop. But still the chances of getting this are very low even at schizophrenia level doses.
> 
> Anyways, if you don't like norepinephrine this drug is for you no doubt. Give it a try for a bit and see how it goes. If you don't like it then you can at least tell your doctor you tried her suggestion and would like your own. I've read of some users on here using this drug maybe you can use the search to see their experiences.


Yeah, Nardil has been a savior, but even with all of my trials it's always caused mood swings and then stopped working. I was attributing it to a raise in dose the previous 2 times, but it may just have been the drug itself and it's effect on NE. I've never made it more than 70+ days on Nardil. Every time I've felt great until day like 40, then it begins to go down hill.

I'll keep that in mind regarding the TD/EPS. I'm guessing it doesn't all come in at once, if anything it'll be small ticks so at least I can stop right away. But even that doesn't sound pleasant. I guess trialing it wouldn't hurt. Thanks for the reply


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## riptide991 (Feb 1, 2012)

gilmourr said:


> Yeah, Nardil has been a savior, but even with all of my trials it's always caused mood swings and then stopped working. I was attributing it to a raise in dose the previous 2 times, but it may just have been the drug itself and it's effect on NE. I've never made it more than 70+ days on Nardil. Every time I've felt great until day like 40, then it begins to go down hill.
> 
> I'll keep that in mind regarding the TD/EPS. I'm guessing it doesn't all come in at once, if anything it'll be small ticks so at least I can stop right away. But even that doesn't sound pleasant. I guess trialing it wouldn't hurt. Thanks for the reply


Yah no idea how it would come in as I never had TD. Even with Zyprexa I had moments where I had like it would cause my muscle to contract and my arm would slightly move for example, but I thought nothing of it as I have experience things like that before, even low magnesium can cause it. But this was going on for days at one point and i'm glad I didn't quit because it ended up going away. I don't even know how TD would even look. I knew this guy at my old job who out of nowhere started getting this shaking in his arm. Almost like Mohammed Ali with parkinsons but it would just tick. It would stop though at points and wouldn't always do it but it was weird cuz he couldn't control it and people would always bring it up because well it was so apparent. That guy was doing a clinical trial for a drug to quit smoking(cham something). I always kind of thought in the back of my mind that it was from that, but I never really brought it up. Of course this started happening a while after he quit the trial and was back to smoking. I wonder if that's what TD would act like.

Anyways, I think the TD situation is overblown even with the more hardcore antipsychotics. At low doses the chances are very small with risperidone. They exist of course because everyone is just so unique, but if a drug like that worked for me and even made my finger tic or something, i'd probably still take it because it would be better than depression hehe. But i'm sure my doctor would probably force me to discontinue.


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## GotAnxiety (Oct 14, 2011)

gilmourr said:


> So... went to my pdoc. Feel a bit rattled, probably the most rattled I've been leaving a pdoc's office ever.
> 
> We talked about mixed states for a bit but she thought mainly that I'm a MDD rather than bipolar or mixed state. That's fine, although I wish she would've reached her conclusion in a more substantiated way.
> 
> ...


I'd take the risperidone its a 5ht1a antagonist it like thé only one you can get. I was on that as a kid i never had no problems.


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## gilmourr (Nov 17, 2011)

jameslp3230 said:


> Your psychiatrist is full of sh*t, 100%. Change if you can. They are more retards than good ones, they ALWAYS diagnose MDD alone as it's easiest and many are unaware of the bipolar spectrum or even mixed states. Seriously, one of my psychiatrists did not know what one is and unequivocally denied I was bipolar. I then saw one who had a brain and he told me as if I don't know "50% of those who present with MDD actually have a form of bipolar illness", lol, but at least he knew.
> 
> Risperidone is a POS. You can try it but what good will it do you I have no idea. Might decrease agitation but then it caused akathisia in me like a ******. F*king doctors I swear. You don't have to get her to diagnose, and yes, might make sense to keep MDD on there just so you can try DBS. I know cingulotomies are done for bipolar depression but DBS is very new so they might not do it for bipolar.
> 
> ...


Yeah, for being the head of the psychiatry department of the hospital I go to, I was quite surprised when she began talking to me. She seemed rather out of it and didn't even read my file before hand... I'll see her a few more times most likely since I just want to try and get zoloft augmented finally.

Right now Zoloft is starting to kick in, I feel less anxious, less depressed, more level although I feel like I kind of have a thin brain fog. It doesn't affect my sex drive at all at this dose which is good. The apathy will come, I'm fairly certain.

I'm not really agitated, I just have residual depression and anxiety along with apathy issues normally once I'm 8 weeks + into zoloft.

I'll probably try her 0.5 mg of risperidone just to show her I'm willing to try it out and if it doesn't work I'll get a mood stabilizer.

I really want to try pregabalin, I might get that soon because I'm not down for benzos everyday.

If I were to use risperidone, what dose would you think would be good to start at?


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## gilmourr (Nov 17, 2011)

Segafage said:


> Some great advice in here.
> 
> Gilmourr, I hope you find the right med and feel better :squeeze


Thanks, I always feel like I'm so close once Zoloft stabilizes. I really hope I can find the 2nd med that will get me even closer.


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## GotAnxiety (Oct 14, 2011)

Yeah, antipsychotic can cause alot of cognitive impairment makes me wonder why the hell they are prescribing these for anxiety and depression that can mimic the illness it self.

Me myself I've been taking 2.5mg to 5.0mg seroquel even that amount i developed a dependance on it for sleep it kinda lame. I think it prosexual like viagra it kinda helps anxiety at that dose. Still impairs cognitive and metabolism probably. I've grown a nasty caffeine addiction i can drink it all day.


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## gilmourr (Nov 17, 2011)

not sure if it's because I have a viral flu, but today I feel like absolute crap. Might also just be from Zoloft balancing out still since I've just hit 4 weeks.

Might even go up to 100 mg of Zoloft even if it causes more apathy just to get rid of the major depression.

BTW, can you explain brain kindling james?


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## gilmourr (Nov 17, 2011)

GotAnxiety said:


> Yeah, antipsychotic can cause alot of cognitive impairment makes me wonder why the hell they are prescribing these for anxiety and depression that can mimic the illness it self.
> 
> Me myself I've been taking 2.5mg to 5.0mg seroquel even that amount i developed a dependance on it for sleep it kinda lame. I think it prosexual like viagra it kinda helps anxiety at that dose. Still impairs cognitive and metabolism probably. I've grown a nasty caffeine addiction i can drink it all day.


Maybe I'll stop taking 25 mg of Seroquel then. Though I can't see how it can cause cognitive side effects at 50 mg or less. It basically only hits histamine receptors at that dose and 5HT2A (antagonism). I doubt it has much effect on muscarinic receptors at that dose, especially 2.5 to 5.0 mg.


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## riptide991 (Feb 1, 2012)

gilmourr said:


> Maybe I'll stop taking 25 mg of Seroquel then. Though I can't see how it can cause cognitive side effects at 50 mg or less. It basically only hits histamine receptors at that dose and 5HT2A (antagonism). I doubt it has much effect on muscarinic receptors at that dose, especially 2.5 to 5.0 mg.


I doubt he's thinking of Seroquel given the smallest dose is 25mg. Is he chopping the pill into 10 equal pieces? haha


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## gilmourr (Nov 17, 2011)

kehcorpz said:


> I doubt he's thinking of Seroquel given the smallest dose is 25mg. Is he chopping the pill into 10 equal pieces? haha


Lol he said seroquel. I thought the same thing.


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## gilmourr (Nov 17, 2011)

I was wondering what some users might think about adding a stimulant to my stack of medicine.

I know that I'm not ADHD because I'm not hyper, but I'm forgetful (leave stoves on, forget things like scripts at the doctors office before leaving, meetings, etc all the time), I can't focus on work unless there is complete silence and the smallest things distract me, I lose a LOT of ****, and I zone out a LOT even when watching movies or TV shows, let alone work.

I know the NRI meds don't seem to agree with me, but aren't amphetamines a completely different type of mechanism for releasing monoamines?

Maybe I'm ADD and majorly depressed? I've never tried a stimulant. Of course it will probably make me feel way less depressed, but if it makes me calm wouldn't that be indicative of ADD?


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## CD700 (Apr 22, 2010)

I wonder the same thing about myself Gilmour 

What type of effect does coffee have on you ?


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## gilmourr (Nov 17, 2011)

CD700 said:


> I wonder the same thing about myself Gilmour
> 
> What type of effect does coffee have on you ?


Makes me sweat a bit more but it gives me motivation and I believe a greatly ability to concentrate. I also feel happier. Music sounds better.


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## riptide991 (Feb 1, 2012)

gilmourr said:


> Makes me sweat a bit more but it gives me motivation and I believe a greatly ability to concentrate. I also feel happier. Music sounds better.


Coffee relaxes the hell out of me.

But yah, he meant Coffee enemas.


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## CD700 (Apr 22, 2010)

Eww what

I had a doctor ask me if Marijuana made me hyper one time. Apparently he thinks that's an indication of ADD..

Gilmour If coffee has that kind of effect you should have tried stimulants ages ago ?? It seems like you could get them easy enough 2.


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## GotAnxiety (Oct 14, 2011)

kehcorpz said:


> I doubt he's thinking of Seroquel given the smallest dose is 25mg. Is he chopping the pill into 10 equal pieces? haha


Yeah, i can break those little pills with my finger nails and i eat the tiny tiny crumbs lol.

@Gilmourr

The anti-histamine is what does some of the impairment and brain fog. Modafinil is used as a stimulant seroquel would do the opposite. I wonder what would happen if those were combine.

The alpha blocker part of thé drug is probably thé most useful part. I think im gonna give up seroquel to. I've been craving pop and coffee to much i think it might be related to off set the sedation.


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## gilmourr (Nov 17, 2011)

GotAnxiety said:


> Yeah, i can break those little pills with my finger nails and i eat the tiny tiny crumbs lol.
> 
> @Gilmourr
> 
> ...


When the anti histamine antagonism is at it's peak though you'll be asleep. I feel alert during the day and not sleepy, so I would think that most of it has worn off. Not so sure that the antihistamine is behind the brain fog...probably just is the depression.

For the last 4 days or so I've felt really ****ty again. It's definitely just swinging to balance out (29 days on it now) but it's very uncomfortable. Listening to super depressing music as a result, and can't stop thinking about ways to kill myself and how I'm so ****ed. I don't know how my brain can go back and forth like this. It's not fair.


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## gilmourr (Nov 17, 2011)

...I'm such a ****ing idiot. This proves how cognitively ****ed I am. I was under the impression that 75 mg was my optimal dose when I just read some historical threads I made where 100 mg was the optimal dose.

Hopefully 100 mg kicks in faster being that I have been on 75 mg for 4 weeks already. 

It's honestly depressing to think about how productive, hard working and intelligent I once was; Now I'm just a lazy sloth that is in my head 24/7, out of answers, burned out and parallel to a lobotomized patient.


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## riptide991 (Feb 1, 2012)

gilmourr said:


> ...I'm such a ****ing idiot. This proves how cognitively ****ed I am. I was under the impression that 75 mg was my optimal dose when I just read some historical threads I made where 100 mg was the optimal dose.
> 
> Hopefully 100 mg kicks in faster being that I have been on 75 mg for 4 weeks already.
> 
> It's honestly depressing to think about how productive, hard working and intelligent I once was; Now I'm just a lazy sloth that is in my head 24/7, out of answers, burned out and parallel to a lobotomized patient.


At least you remember a time when you were productive and hard working. I don't think I ever was. I mean after puberty things just went down hill.


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## gilmourr (Nov 17, 2011)

kehcorpz said:


> At least you remember a time when you were productive and hard working. I don't think I ever was. I mean after puberty things just went down hill.


You out depressed me


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## riptide991 (Feb 1, 2012)

gilmourr said:


> You out depressed me


lol just trying to make you feel better


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## gilmourr (Nov 17, 2011)

jameslp3230 said:


> See Chapter 14, Neurobiology, Manic Depressive Illness, by Goodwin & Jamison
> 
> No you most probably don't have ADHD + major depression. In a soft bipolar text I recently read, a certain subtype (mixed state bipolar) can often appear, amongst other things, to have so called ADHD and so called OCPD, just as so many are diagnosed with depression + anxiety when in fact the anxiety is just part of mixed state bipolar.
> 
> ...


I disagree with the Zoloft. It definitely helps. I'm not saying the suicidal thoughts are being caused by zoloft, they aren't. It's the depression because I'm an idiot and was taking 75 instead of my normal 100 mg dose. 50 mg does 0, zilch for me. I need 100 mg.

I agree with Lamictal though. I'll get it since you're so hopeful of it. FOR YOU MAN. hahah. But I'm getting the brand. The generic made my throat close. Or I'm getting a different generic.

I'll read your reference. And I got abilify from my GP, but I'll try the lamictal first again. Thanks for the help and I hope it really does work without closing my throat this time.

EDIT: Also found out today that I'm a normal metabolizer for all antidepressants and antipsychotics except for escitalopram, citalopram, sertraline and amitryptiline which I'm slower.

Might make sense because on escitalopram and citalopram I went to the max dose and I was awake for days on end. It was torture. I think that's good news though at least! And that maybe a lower dose of citalopram or escitalopram might work in the future, who knows. But with sertraline working as my AD (or it should very soon) I don't have any need for another SSRI.


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## GotAnxiety (Oct 14, 2011)

CD700 said:


> Eww what
> 
> I had a doctor ask me if Marijuana made me hyper one time. Apparently he thinks that's an indication of ADD..
> 
> Gilmour If coffee has that kind of effect you should have tried stimulants ages ago ?? It seems like you could get them easy enough 2.


Alcohol makes me hyper does that mean I have ADD?. I'm talking like the next day during the hangover.


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## gilmourr (Nov 17, 2011)

100 mg is definitely doing the trick for the major depression, I feel quite a bit better.

It has also helped the anxiety more too, but I think 100 mg is the max that Zoloft gives me as to effect vs side effects. 

Tomorrow I'll see about Lamictal and everything.

I'm definitely feeling the apathy and a greater lack of motivation from the Zoloft, but at least I don't feel really bad per say. At least I can read again pretty much... I don't have bombarding suicidal thoughts as much.


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## A Sense of Purpose (May 8, 2011)

gilmourr said:


> 100 mg is definitely doing the trick for the major depression, I feel quite a bit better.
> 
> It has also helped the anxiety more too, but I think 100 mg is the max that Zoloft gives me as to effect vs side effects.
> 
> ...


Although im not completely at the 'therapeutic level' of lamictal i do notice a significant difference to just prozac and olanzapine. Im currently at 50 and titrating up to 200-400mg. GL with your journey. 

Ill also be swapping the prozac to Zoloft again as its a better antidepressant for me. The only difference between us is that ill be also on olanzapine


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## gilmourr (Nov 17, 2011)

TWINS. 

I'm about 90% sure that I won't be able to tolerate the lamictal but you never know.

You said olanzapine actually made you happier/more concentrated correct? 

Zoloft really makes me lazy. Not in a tired way, just in a meh kind of way. My dreams are really bad though, it's crazy. 

I HOPE that the concentration/motivation issue is just a residual depression thing because I don't like the idea of stimulants and zoloft.

EDIT: Also, my memory is still awful. I keep leaving things out like the milk or forgetting about leaving things on. I feel like I'm developing alzheimers at 22.


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## gilmourr (Nov 17, 2011)

Been having nightmares every night, just awful. The only side effect I have of Zoloft besides the apathy. Just feel like **** upon waking up after having nightmares all night.

Can't get to my psych either because I'm really sick so this is rather balls.

I wonder if an antipsychotic antagonizing some serotonin receptors might help with the nightmares caused by zoloft.


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## jim_morrison (Aug 17, 2008)

gilmourr said:


> Been having nightmares every night, just awful. The only side effect I have of Zoloft besides the apathy. Just feel like **** upon waking up after having nightmares all night.
> 
> Can't get to my psych either because I'm really sick so this is rather balls.
> 
> I wonder if an antipsychotic antagonizing some serotonin receptors might help with the nightmares caused by zoloft.


I haven't been following this thread very closely but prazosin seems to be pretty highly rated for nightmare reduction, might be worth looking into.


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## gilmourr (Nov 17, 2011)

jim_morrison said:


> I haven't been following this thread very closely but prazosin seems to be pretty highly rated for nightmare reduction, might be worth looking into.


I actually saw that when I looked at medications that treat nightmares on drugs.com

I'm not sure if they're nightmares per say, but they're so lucid to the point they're uncomfortable + half the time they are nightmares--actually, I'd say 3/4 of the time.

I just started 2 mg of Abilify today as I don't think I'll be able to get Lamictal until I'm better which might take a week. Might as well trial this first. The active metabolite has a half life of 94 hours :/ So 450 hours about or 18 ish days?!? Does it really take that long to reach steady state? Keh, if you're floating around can you let me know how long it took for you to feel something from Abilify?

EDIT: Also just realized that I should probably take 1 mg tomorrow as I'm using an antibiotic I believe is clarithrymycin which elevates abilify levels by 5x I believe. I know that seroquel has been knocking me on my *** at 12.5 mg still


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## riptide991 (Feb 1, 2012)

I'm really desensitized from all the violence in movies. I have what people would consider crazy nightmares but they don't even phase me hah.

Abilify was pretty quick to act. You should feel it within a week doing something. It's pretty powerful stuff.


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## gilmourr (Nov 17, 2011)

I guess antibiotics make the abilify quite a bit stronger as I felt super nauseated today + tired though unable to sleep at the same time.

Definitely doing just 1 mg with the antibiotics until I'm off them, then I'll go back to 2 mg.


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## gilmourr (Nov 17, 2011)

Hush7 said:


> :lurk
> 
> If my head weren't so cloudy, I could have written this myself word for word. Zoloft has made me lazy in the meh kind of way and in the tired kind of way. Which lazy feeling I have changes on a day to day basis.
> 
> ...


I don't think I'll ever get used to daily nightmares. Definitely going to try and grab prazosin to help with that.

Whenever I forget about things it's because I'm thinking about something depressing or pondering a new medication choice, so I think it's just residual depression getting in the way--hopefully.


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## gilmourr (Nov 17, 2011)

Definitely going to finish my antibiotic first before trying abilify. It must've been like I was taking 10 mg with the clarithyrmycin inhibiting the clearance of abilify.

I couldn't be asleep for more than 1 hour at a time. Had nightmares + intermittent awakenings. 

Hopefully 2 mg when I'm off the antibiotics is better because with the LARGE amounts of nausea I was experiencing + the insomnia, abilify did not feel good for me at all. At least it seems that the abilify has stopped any sweaty/claminess.


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## jim_morrison (Aug 17, 2008)

Yeah macrolide antibiotics can do that with alot of psych meds unfortunately. It's probably raising seroquel levels too or is it normal for 12.5mg to knock you out?


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## gilmourr (Nov 17, 2011)

jim_morrison said:


> Yeah macrolide antibiotics can do that with alot of psych meds unfortunately. It's probably raising seroquel levels too or is it normal for 12.5mg to knock you out?


No, it's not normal for me to experience the effects that it caused at 12.5 mg.

Usually I take 25 mg and it causes no hangover, but 12.5 mg did. I decided not to take seroquel with abilify yesterday because abilify hits histamine receptors. I probably could've used more histamine antagonism.

I'm intrigued by abilify atm as it seems like a fairly potent drug. Or maybe it's just because I took the equivalent of about 10 mg.

I might just stop my antibiotic as I don't think it's bacterial (no fever) + after 5 days it doesn't feel a whole lot better. Bacterial infections get better fairly quickly with antibiotics.


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## gilmourr (Nov 17, 2011)

Got back from my psych today. Talked about how I didn't want to use clonazepam every day at 0.5 mg at night and morning. I think it can cause some irreparable damage to my brain taking it every single day. Also I don't want to be dependant, though she assured me that dependence is not formed on 0.5 mg/twice a day and the therepeutic range of clonazepam can go up to about 12 mg.

Neurontin was side lined because she considers it a med that is more for epilepsy and they really are against using gabapentin or pregabalin and more inclined to use benzos. I found this weird.

We talked about adding an augment. I brought up lamictal, but she said that it's more used for neurological conditions like seizures. I told her that it was FDA approved for bipolar and mixed states and she didn't think that I was a person with mixed states. The only evidence of this is from NRI's always causing suicidal and depressive issues. I can only use SSRI's.

She wants to either go with 0.5 mg of risperidone or 2 mg of abilify when I'm done my antibiotics. 

Does anyone here have some advice for me? Zoloft kills about 60% of my depression but I have major memory issues and concentration/motivation issues. My anxiety is decent as well, about 50% reduced from where I started. So I need a few meds to manage more of my anxiety and depression but not lower cognitive functioning. Ideas?

I'd love it if some people brought out some alternative ideas med wise. 

I want to enroll in the fall semester but I know at this point, my concentration and motivation is so low that I really would not do well. I want to fix this more before going back to school.

EDIT: Is there a difference between taking 0.5 mg/2 times a day and 0.5 mg PRN? Will taking it twice a day keep it at a steady state and offer a much better anxiolytic response? I know 0.5 mg PRN is barely helpful, it just puts me to sleep for the most part. Benzos don't really make me less anxious, just tired.


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## gilmourr (Nov 17, 2011)

Past week has been interesting. 

It seems like when I was on my antibiotics with zoloft it made me feel even less anxious and maybe even less depressed. Guessing because it inhibited Zoloft and made it closer to 175 or 200 mg for the last 10 days or so.

I felt a bit queasy starting the antibiotics (might be because of the dose going higher because of the interaction) and now I'm feeling a bit queasy day 2 since going off my antibiotics, so it might be leveling back down to my normal 100 mg dose.

I think I'll go up to 125 mg and try it again. Last time when I did 125 mg I thought I felt more apathy, but maybe I was wrong. Maybe 200 mg might even work. 

I know when I rushed up to 200 mg the first time, I had like IBS as a side effect. But that was also because I didn't take it with food and titrated mega fast. Maybe I can actually handle a stronger dose and maybe it's better for me? :idea

What do you guys think? How much would you increase it by? 25, 50, 75, 100 mg? I'm at 100 mg. Technically clarithrymycin should've increased it 1 fold up to 200 mg.


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## VERBW (Jul 23, 2013)

gilmourr said:


> Past week has been interesting.
> 
> It seems like when I was on my antibiotics with zoloft it made me feel even less anxious and maybe even less depressed. Guessing because it inhibited Zoloft and made it closer to 175 or 200 mg for the last 10 days or so.
> 
> ...


I had a quick look through your recent posts, and thought I'd give you some feedback. Hopefully it will help!

1) There is poor evidence for increasing SSRI doses to high levels. I would personally try a different drug instead. 200mg is supposedly the maximum amount of Sertraline you should take - according to the BNF, at least - but I can't imagine it will make much of a difference

2) Pregabalin is a great drug. I can't speak for Neurontin, but Pregabalin really, really helps with my anxiety - and I'm only on a small dose of it. It doesn't work for everyone, which is a shame, but I would definitely say it was worth trying. They are definitely preferable to Benzodiazapines, which as you know, can cause dependence. Not that there isn't a time and place for Benzos, but Pregabalin is "safer" in that respect.

3)Antidepressants - the first thing you can do, is add an NRI - Noradrenaline Reuptake Inhibitor. That would work well with Setraline. You have a few options there: Nortriptyline or Reboxetine. Nortriptyline is a clean drug with few interactions.

4) Alternatively, you can switch to a Tricyclic. I can personally recommend Clomipramine or Imipramine. Amitriptyline is also supposedly good, but I suspect it's a little bit weaker.

5) You could try Mirtazapine. Very sedating, so take it at night - it's often used to augment antidepressants.


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## riptide991 (Feb 1, 2012)

VERBW said:


> I had a quick look through your recent posts, and thought I'd give you some feedback. Hopefully it will help!
> 
> 1) There is poor evidence for increasing SSRI doses to high levels. I would personally try a different drug instead. 200mg is supposedly the maximum amount of Sertraline you should take - according to the BNF, at least - but I can't imagine it will make much of a difference


I disagree with that. For instance higher levels of sertraline are actually said to benefit OCD more than lower doses. Second, if you look at the studies available for most drugs you have quite a large coefficient of variance for things like bioavailability. This means that some people really do need to take more of a drug just to achieve the same blood levels as someone taking less. While it's true that the majority may respond to these levels, the studies do show that there are people who need more to achieve the same level of occupancy. Typically you want to achieve 80% occupancy for effectiveness. 1 person may achieve this with 50mg of sertraline, the other may with 200mg. So I think it's worth pushing a drug to at least the maximum dose available if it doesn't seem to be helping at the lower doses. I was actually one of those people who responded to 200mg of Zoloft but did not for anything lower.


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## jim_morrison (Aug 17, 2008)

gilmourr said:


> We talked about adding an augment. I brought up lamictal, but she said that it's more used for neurological conditions like seizures. I told her that it was FDA approved for bipolar and mixed states and she didn't think that I was a person with mixed states. The only evidence of this is from NRI's always causing suicidal and depressive issues. I can only use SSRI's.
> 
> She wants to either go with 0.5 mg of risperidone or 2 mg of abilify when I'm done my antibiotics.


2.5 - 5mg of Saphris in place of risperdal/abilify perhaps. It seems like shes underestimating the usefulness of Lamictal, but if she's dead against it there are alternatives such as Trileptal I suppose. This is all assuming that you have bipolar depression - as seems to be indicated by your initial post.


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## VERBW (Jul 23, 2013)

kehcorpz said:


> I disagree with that. For instance higher levels of sertraline are actually said to benefit OCD more than lower doses. Second, if you look at the studies available for most drugs you have quite a large coefficient of variance for things like bioavailability. This means that some people really do need to take more of a drug just to achieve the same blood levels as someone taking less. While it's true that the majority may respond to these levels, the studies do show that there are people who need more to achieve the same level of occupancy. Typically you want to achieve 80% occupancy for effectiveness. 1 person may achieve this with 50mg of sertraline, the other may with 200mg. So I think it's worth pushing a drug to at least the maximum dose available if it doesn't seem to be helping at the lower doses. I was actually one of those people who responded to 200mg of Zoloft but did not for anything lower.


You're probably right. There's no harm in trying a higher dose, providing side effects are minimal.

But, it should be done quickly. You shouldn't waste time on a drug that has no sign of effectiveness. 100mg of Sertraline really should be enough. Evidence for increasing the dosage to higher levels is poor, but as you point out, it's not as if it definitely won't help. For some people it will; it's just not hugely likely.

If you are in a desperate situation, feeling very suicidal, I would personally choose a new drug. You may have a differing view, and that's fine.


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## gilmourr (Nov 17, 2011)

jim_morrison said:


> 2.5 - 5mg of Saphris in place of risperdal/abilify perhaps. It seems like shes underestimating the usefulness of Lamictal, but if she's dead against it there are alternatives such as Trileptal I suppose. This is all assuming that you have bipolar depression - as seems to be indicated by your initial post.


Is it available in Canada? I didn't think it was.


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## gilmourr (Nov 17, 2011)

VERBW said:


> I had a quick look through your recent posts, and thought I'd give you some feedback. Hopefully it will help!
> 
> 1) There is poor evidence for increasing SSRI doses to high levels. I would personally try a different drug instead. 200mg is supposedly the maximum amount of Sertraline you should take - according to the BNF, at least - but I can't imagine it will make much of a difference
> 
> ...


1) I think Keh did a good job summarizing what I'd reply with.

2) Yep, I want it. Hopefully I'll get it soon

3) I don't think I can handle NRI's. Every NRI has made me suicidal. Parnate, Nardil, Cymbalta..

4) I could, but all TCA's have a NRI component except amitryptiline I think which is basically histamine/serotonin and some effect on BDNF and sigma receptors I think?

5) Can't. Major acne and I sleep 16 hours a day on 12.5 mg. Tried it. Way too sedating and when I'm awake I feel like I want to sleep.


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## gilmourr (Nov 17, 2011)

I'm not sure what happened, but these last 2 days have been killer on my mental well being. I usually never drink much, but I drank way too much this past weekend and blacked out. Maybe I just need rest but I feel so ****ing depressed right now. And Zoloft was KILLING it. Well, killing it in a way where I can get by. I've been doing really well lately.

It also might be because I raised my dose to 125 mg. I changed it 4 days ago and 1.5 days ago I started to feel this dark cloud over me, weighed down, head stuffy and unable to think. Going back to 100 mg.

Sucks because I wanted to get on Abilify tomorrow, but I need to go back to 100 mg as I think 125 does me harm. Or I might have just ****ed it all up from drinking or it might just be a low point from drinking a lot this weekend.

I hope in 2-3 days I'm back to where I was. Zoloft really does kick *** for me. I'm really almost in remission with it besides the daily nightmares and concentration issues/minor depressive periods


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## riptide991 (Feb 1, 2012)

If you can handle the side effects, give it 2 weeks for your brain to adjust to the higher dose. Likely the depression/dark cloud is temporary. It's like starting the drug all over again.


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## gilmourr (Nov 17, 2011)

kehcorpz said:


> If you can handle the side effects, give it 2 weeks for your brain to adjust to the higher dose. Likely the depression/dark cloud is temporary. It's like starting the drug all over again.


It really didn't feel right man. I'm not sure whether it's the alcohol but I've gone back to 100 mg today and so far I feel better. I'll try 125 mg again in a few weeks, but right now I'm just going to stay on 100 mg and add my 2 mg of abilify.

Right now it's been 2 hours and I haven't felt any side effects that were like last time when I was on antibiotics (thought that was 10 mg as an equivalent).


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## gilmourr (Nov 17, 2011)

Day 1 (2MG abilift). Felt tired, bit hungry, no nausea at all this time I believe, and a bit restless. I also think I experienced some minor tremors.
Sweated a bit excessively/clammy hands/feet and had moments of feeling some chills.

It wasn't too bad, so I'll keep on trekking. Depression is getting better taking the 100 mg instead of the 125 mg still. 

I really need abilify to help with my concentration/cognitive issues. My memory and capability to work are compromised greatly. 

If anyone took abilify, how long before you felt an effect? I heard it's rather fast acting, like 5-7 days.


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## riptide991 (Feb 1, 2012)

gilmourr said:


> Day 1 (2MG abilift). Felt tired, bit hungry, no nausea at all this time I believe, and a bit restless. I also think I experienced some minor tremors.
> Sweated a bit excessively/clammy hands/feet and had moments of feeling some chills.
> 
> It wasn't too bad, so I'll keep on trekking. Depression is getting better taking the 100 mg instead of the 125 mg still.
> ...


Yah it will be pretty quick but only once you find the right dosage. If the restlessness gets bad I would raise it to 5mg. I had more restlessness at the lower dose.


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## gilmourr (Nov 17, 2011)

kehcorpz said:


> Yah it will be pretty quick but only once you find the right dosage. If the restlessness gets bad I would raise it to 5mg. I had more restlessness at the lower dose.


Still need a week to analyze the restlessness but so far after 24-48 hours I don't feel that restless. I feel very tired during the day when I take it in the morning so I might switch to night.

I'm hoping this helps with residual depression because I think that's what is affecting my memory and cognitive functioning. Keh, did abilify help you concentrate?

What was the first thing you noticed when it started working?


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## MoonForge (Sep 15, 2012)

I'm using Welbutrin myself, and i got warned ahead of time that it would first cause my depression to get worse before it got better, and that took about 2 months before it actually got a bit better, i mean it does work for me, but yeah it did make my mood go down the drain for quite a long time, i don't know much about the other two meds you're taking even though i've had zoloft but it drove me crazy, but i think its probably the Welbutrin, and i hope my experience with it helps you a bit : o


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## riptide991 (Feb 1, 2012)

gilmourr said:


> Still need a week to analyze the restlessness but so far after 24-48 hours I don't feel that restless. I feel very tired during the day when I take it in the morning so I might switch to night.
> 
> I'm hoping this helps with residual depression because I think that's what is affecting my memory and cognitive functioning. Keh, did abilify help you concentrate?
> 
> What was the first thing you noticed when it started working?


Honestly I don't remember. My memory is kind of ****ty right now too as it hasn't recovered since i stopped all my other meds. Im pretty sure the abilify did help concentration though.


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## basuraeuropea (Jul 25, 2012)

VERBW said:


> 2) Pregabalin is a great drug. I can't speak for Neurontin, but Pregabalin really, really helps with my anxiety - and I'm only on a small dose of it. It doesn't work for everyone, which is a shame, but I would definitely say it was worth trying. They are definitely preferable to Benzodiazapines, which as you know, can cause dependence. Not that there isn't a time and place for Benzos, but Pregabalin is "safer" in that respect.


i agree that pregabalin is a wonder drug - i take it, in fact, and it is the core of my treatment. it's efficacy in treating my generalised anxiety disorder and panic disorder is stunning, to say the least.

that said, it can, just as the benzodiazepines, cause physiological dependence, as well as abuse and addiction. that it, and it's closely-related sibling gabapentin do not, are common misconceptions/fallacies held.

tolerance, physical dependence as well as psychological/physiological addiction and abuse have been reported with pregabalin/lyrica and neurontin/gabapentin more and more as their use is increasing. withdrawal from pregabalin and its cousin gabapentin can be horrific, and both drugs' withdrawal symptoms frequently mimic those associated with gabaergic drugs, particularly benzodiazepines and ethanol.

http://onlinelibrary.wiley.com/doi/1...200.x/abstract
http://www.ncbi.nlm.nih.gov/pubmed/22822593
http://www.ncbi.nlm.nih.gov/pubmed/21212719
http://www.ncbi.nlm.nih.gov/pubmed/20595436
http://www.ncbi.nlm.nih.gov/pubmed/22725618
http://www.ncbi.nlm.nih.gov/pubmed/21068226

while the gaba analogues haven't been studied a terrible amount with regard to the aforementioned, the information is rather clear. additionally, the aforementioned are just a few clinical studies/case reports - if you google, you'll find a host of anecdotal information regarding the salient issues at hand. the longer the drug has been on the market and the more it is taken the more core problematic issues will begin to arise - i mean, the benzodiazepines were also marketed and widely regarded for quite some time as not having the dependency issues associated with the barbiturates.


----------



## gilmourr (Nov 17, 2011)

basuraeuropea said:


> i agree that pregabalin is a wonder drug - i take it, in fact, and it is the core of my treatment. it's efficacy in treating my generalised anxiety disorder and panic disorder is stunning, to say the least.
> 
> that said, it can, just as the benzodiazepines, cause physiological dependence, as well as abuse and addiction. that it, and it's closely-related sibling gabapentin do not, are common misconceptions/fallacies held.
> 
> ...


God I want pregabalin so badly. I can't get anything except .5 mg benzos from my new psych. She thinks that .5 mg everyday is better and I keep telling her that it makes me feel super slow and lazy.

Neurontin handled my anxiety very well and I didn't feel disabled in the head.


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## basuraeuropea (Jul 25, 2012)

gilmourr said:


> God I want pregabalin so badly. I can't get anything except .5 mg benzos from my new psych. She thinks that .5 mg everyday is better and I keep telling her that it makes me feel super slow and lazy.
> 
> Neurontin handled my anxiety very well and I didn't feel disabled in the head.


yeah, its been a godsend. perhaps think about changing psychiatrists if she doesn't prescribe you pregabalin.

pregabalin + clonazepam = no anxiety for me


----------



## gilmourr (Nov 17, 2011)

basuraeuropea said:


> yeah, its been a godsend. perhaps think about changing psychiatrists if she doesn't prescribe you pregabalin.
> 
> pregabalin + clonazepam = no anxiety for me


I'm giving her 2-3 months, max 4 then I'll move on.

Feeling more depressed since starting abilify. Not the greatest..


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## gilmourr (Nov 17, 2011)

Day 3. Took it at night. Felt tired in the morning and a bit anxious today, but overall taking it at night seems better. Haven't felt anything yet


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## gilmourr (Nov 17, 2011)

Day 4

Feel kind of again mildly depressed (worse than Zoloft 100 mg alone) and nausea that might be from a bit of the anxiety getting worse. Side effects are pretty tolerable atm.

Sorry if I'm like spamming, but I just want to get a good record of abilify on here to look back on it. After the first week I'll probably post every 3 days. It's just the first week or two are usually side effects that I may/may not forget.

Oh, and nothing yet from abilify. Though it might have lessened my sweating from Zoloft. Maybe partial agonist activity on 5HT1A? That might also be undoing the work of zoloft :O

EDIT: HAI KEH.


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## gilmourr (Nov 17, 2011)

Day 5

Anxiety and depression are okay, both still a bit higher than Zoloft originally.

Nauseated mildly at points throughout the day. Pepto bismol doesn't help, only clonazepam, so I'm guessing it's mental.

I feel like I have possibly a bit higher sex drive and more motivation or at least it's starting. 

Maybe good things to begin? 

I kinda would rather just be on Zoloft + Vyvanse + Pregabalin. That sounds like a ball. Or Zoloft Lamictal Pregabalin


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## gilmourr (Nov 17, 2011)

Day 7. I think the abilify induced anxiety is leveling out.

I have yet to feel some drastic effect from abilify. I feel as if my cognitive state is still as impaired as before and that my motivation has moderately increased while my concentration hasn't.

Anyone want to provide some anecdotal stories of their good time on Abilify? Could use some optimism.

I also think I'm addicted to going out atm since my depression has yet to be fully managed. I go out 4-5 days a week, not always drinking, either parties or casual dinners, coffees, things with girls because I hate being at home. I used to be cool with being at home/relaxing and doing work...but without my concentration I just want to be out. Because when I'm talking to people I block any negative thoughts since my mind is being preoccupied by talking.


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## riptide991 (Feb 1, 2012)

Damn I'd love to be going out and being social but just don't have it in me. Right now it just seems boring to me.

If you don't have the restlessness with abilify then just stick it out. The restlessness is what makes people abandon it quickly. Sometimes it gets horrendous.


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## gilmourr (Nov 17, 2011)

That sucks. I'm pretty dam close to remission. It's good to be at this point after 2.5 years.

I've put on 15 pounds since starting ability but it's fine since I'm super underweight.


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## riptide991 (Feb 1, 2012)

gilmourr said:


> That sucks. I'm pretty dam close to remission. It's good to be at this point after 2.5 years.
> 
> I've put on 15 pounds since starting ability but it's fine since I'm super underweight.


That's nuts my weight never budged on any drug other than olanzapine and it was something that wasn't hardcore noticeable like 15lbs hehe.


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## gilmourr (Nov 17, 2011)

12 days in I'm feeling pretty damn good. I'm getting more motivation and energy and am feeling even more stable. Though I'm having some spells of nausea that will not work in the long term unless it dies down.

So hopefully after 5-6 weeks the nausea subsides because Abilify is definitely doing what I hoped it would! Remission here I come yo!


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## gilmourr (Nov 17, 2011)

Not sure if I have the flu but I'm super nauseous this morning.

Taking .5 mg klon to see if it's just the upregulation of dopamine from abilify.


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## gilmourr (Nov 17, 2011)

15 days in and yesterday I had some nausea while out. Might've been anxiety induced by the abilify..

Also feeling a little bit in my head this afternoon very oddly. Maybe it's just because I'm super tired or something. Maybe it's just a minor rough period.

I plan to give this 6 weeks, so that's what I'm going to do. 

But as it stands now, I'm having minor depression and minor anxiety resurge.


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## gilmourr (Nov 17, 2011)

16 days in.

Maybe this isn't the medication for me...

I woke up like 10 times during the night and I'm so damn tired at the same time. Worst sleep I've ever had in my life.

Maybe early on in treatment I was getting the dopamine actions and now I'm getting the serotonin effects. It's almost reached steady state. Day 21 is coming.


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## riptide991 (Feb 1, 2012)

Yah at this point you can tell if you will like the med or not.

Parnate messes with my sleep too but in a weird way. I mean I can go to bed early and sleep fine, but I always wake up super early from 4am-6am. It doesn't matter what time I go to bed. If I go to bed at 11pm I will still wake up at those times and just get less sleep. So to get more sleep I need to go to bed at like 9pm.


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## depressed77 (Dec 9, 2010)

gilmourr said:


> 16 days in.
> 
> Maybe this isn't the medication for me...
> 
> ...


Hang in there. May I ask what your current combination is, I guess your signature is outdated.

/depressed77


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## gilmourr (Nov 17, 2011)

kehcorpz said:


> Yah at this point you can tell if you will like the med or not.
> 
> Parnate messes with my sleep too but in a weird way. I mean I can go to bed early and sleep fine, but I always wake up super early from 4am-6am. It doesn't matter what time I go to bed. If I go to bed at 11pm I will still wake up at those times and just get less sleep. So to get more sleep I need to go to bed at like 9pm.


Parnate also made me completely tired from insomnia. How many days in are you?

I'm thinking about going up to 5 mg to possibly see if it will help me sleep better.

Or maybe I'll just take it during the day.


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## riptide991 (Feb 1, 2012)

gilmourr said:


> Parnate also made me completely tired from insomnia. How many days in are you?
> 
> I'm thinking about going up to 5 mg to possibly see if it will help me sleep better.
> 
> Or maybe I'll just take it during the day.


Oh you're still on 2.5mg. Yah you usually go to 5m pretty quickly figured you were on it by now. Sucks cuz now you have to give 5mg enough time.


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## gilmourr (Nov 17, 2011)

depressed77 said:


> Hang in there. May I ask what your current combination is, I guess your signature is outdated.
> 
> /depressed77


100 mg Zoloft (morning, chills me out more; I like it.)
2 mg Abilify (at night. Just switched it now)
0.5 mg clonazapam PRN
25 mg seroquel (at night)

Without abilify I feel quite damn good except for the apathy and unmotivated feeling. Also things don't feel as enjoyable. I'm close.

And ty, I will hang in as my depression is fairly mild and so is my anxiety. The lack of sleep is affecting my mental state and making me feel like **** fairly quickly though. Maybe all use a non-benzo tonight. I've got imovane, trimipramine, doxepin, seroquel for sleep. A bunch if I want one.


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## gilmourr (Nov 17, 2011)

Almost 3 weeks in I believe. Might even be 3 weeks. I don't have many side effects other than sleep troubles, but I feel more anxious and more depressed since starting abilify.

Somehow I have motivation though and more reward. Guessing this is the D2 mechanism.

I felt pretty god damn depressed though the other day, like death thoughts resurfacing...

Not sure what to do. I know more than 100 mg of Zoloft makes me feel more depressed. I think Zoloft is an inhibitor so my abilfy would probably be more than 2 mg in real life.

Advice? Should I try Zyprexa? My concentration is still a bit wack and so is my energy.

EDIT: I've got access to risperidone, zyprexa and nortriptyline as augmentors. Maybe I should use trimipramine at a therepeutic dose..


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## depressed77 (Dec 9, 2010)

gilmourr said:


> Almost 3 weeks in I believe. Might even be 3 weeks. I don't have many side effects other than sleep troubles, but I feel more anxious and more depressed since starting abilify.
> 
> Somehow I have motivation though and more reward. Guessing this is the D2 mechanism.
> 
> ...


Keep it as it is, but add Lamictal.

/depressed77


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## gilmourr (Nov 17, 2011)

depressed77 said:


> Keep it as it is, but add Lamictal.
> 
> /depressed77


reasoning?


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## depressed77 (Dec 9, 2010)

gilmourr said:


> reasoning?


I know people who have responded well to Abilify + Lamictal. AAP + Lamictal in general seems to be a combination with a fair chance of success. I have good experiences with it too.

/depressed77


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## riptide991 (Feb 1, 2012)

gilmourr said:


> Almost 3 weeks in I believe. Might even be 3 weeks. I don't have many side effects other than sleep troubles, but I feel more anxious and more depressed since starting abilify.
> 
> Somehow I have motivation though and more reward. Guessing this is the D2 mechanism.
> 
> ...


Well, out of all the AAPs zyprexa is my favourite. Only reason I stopped was because of blood sugar problems. You could give it a try, it will be different for you maybe, who knows, but drugs are trial and error unfortunately.


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## gilmourr (Nov 17, 2011)

Yeah, was just wondering what you guys mainly thought personally.

ATM I sleep okay, have developed some mild-moderate depression and mild floating anxiety since being on abilify. It helps with motivation but I don't think that's a fair trade off atm. And when I say motivation I don't mean concentration. I just want to do work, but I'm still unable to concentrate exceptionally well. I don't expect it to all come back at once, but I know my basic concentration level. 

I need something working on norepinephrine somehow without swinging me...

I want to try nortryptiline possibly. Maybe an NRI with alpha 1 antagonism will cause it to go to alpha 2 mainly which is more sedating/calming. It might give me a good balance, plus I heard MANY people have been helped with it. Along with amitryptiline.


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## depressed77 (Dec 9, 2010)

gilmourr said:


> Yeah, was just wondering what you guys mainly thought personally.
> 
> ATM I sleep okay, have developed some mild-moderate depression and mild floating anxiety since being on abilify. It helps with motivation but I don't think that's a fair trade off atm. And when I say motivation I don't mean concentration. I just want to do work, but I'm still unable to concentrate exceptionally well. I don't expect it to all come back at once, but I know my basic concentration level.
> 
> ...


Good luck. Have you tried modafinil? Nothing gives me concentration like this one.

/depressed77


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## riptide991 (Feb 1, 2012)

Yah nortriptyline would be your best choice for that. Though watch out sometimes NRIs can cause erectile difficulties. But yah personally I loved zyprexa, but keep in mind that while on it with the effexor it got me out of my rut, so i'm very biased lol. I was able to concentrate really well on it, my guess is because it's such a powerful 5-ht2c antagonist. It also blocks serotonin receptors that help with memory like 5-ht6 receptors which increases cholinergic/glutamergic activity.


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## gilmourr (Nov 17, 2011)

depressed77 said:


> Good luck. Have you tried modafinil? Nothing gives me concentration like this one.
> 
> /depressed77


I have not. I think this would be too stimulating though. How much anxiety does it give you? It might be hard to get.


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## gilmourr (Nov 17, 2011)

kehcorpz said:


> Yah nortriptyline would be your best choice for that. Though watch out sometimes NRIs can cause erectile difficulties. But yah personally I loved zyprexa, but keep in mind that while on it with the effexor it got me out of my rut, so i'm very biased lol. I was able to concentrate really well on it, my guess is because it's such a powerful 5-ht2c antagonist. It also blocks serotonin receptors that help with memory like 5-ht6 receptors which increases cholinergic/glutamergic activity.


Never knew that antagonism at the 5HT2C receptor and 5HT6 cause an increase in concentration. Time to look whether abilify does this at a low affinity. And Zyprexa might be my next move. Just really worried about the man boobs, lactating issue.

EDIT1: It's actually a partial agonist at the 5HT2C receptor and doesn't touch 5HT6 really, so yeah, no help there for me taking abilify  Feeling quite nauseous today and it's I think 21+ days now. I will be upping to 5 mg on Sunday after the weekend or moving to something else. I probably will try 5 mg of Abilify for 7-10 days and if that doesn't work well I'll probably think about another.

I'm getting heartburn and insomnia and heightened anxiety and depression with abilify with only motivation going up. It's not that great so far.


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## depressed77 (Dec 9, 2010)

gilmourr said:


> I have not. I think this would be too stimulating though. How much anxiety does it give you? It might be hard to get.


It's a quite tricky medication, sometimes it gives me confidence and makes me less anxious and sometimes it makes me anxious. I frequently used atenolol with it.

/depressed77


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## gilmourr (Nov 17, 2011)

Due to the extreme tiredness and side effects of abilify, I'm going to stop it a bit soon. I might come back and try 5 mg another time, but 2 mg really should be doing more at 23-24 days in, plus I keep having really bad nausea spells and I just think another med might be better.

Zyprexa or nortryptiline seem less symptom causing


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## A Sense of Purpose (May 8, 2011)

Zyprexa is delicious. Works like a charm with Zoloft.


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## depressed77 (Dec 9, 2010)

gilmourr said:


> Due to the extreme tiredness and side effects of abilify, I'm going to stop it a bit soon. I might come back and try 5 mg another time, but 2 mg really should be doing more at 23-24 days in, plus I keep having really bad nausea spells and I just think another med might be better.
> 
> Zyprexa or nortryptiline seem less symptom causing


At this point it should be doing more. +1 for nortriptyline.

/depressed77


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## gilmourr (Nov 17, 2011)

Stopped abilify. Hard decision to make between Zyprexa, Nortryptiline, and Lamictal.

Zyprexa is interesting at low doses and works well with zoloft.
May cause sexual issues. 

Nortryptiline might help with focus and energy + AD effect. Good with zoloft too.

Glutamate may be the BIG anxiety provoker for me and lamictal manages this well and is something new. So it's an interesting take.


I'll probably go nortrip just because I have it already.


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## riptide991 (Feb 1, 2012)

Just do both nortrip and olanzapine


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## gilmourr (Nov 17, 2011)

What about desipramine?

Out of lamictal, nortryptline, desipramine and zyprexa what may be the order of sexual side effects? Worst to best.


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## riptide991 (Feb 1, 2012)

gilmourr said:


> What about desipramine?
> 
> Out of lamictal, nortryptline, desipramine and zyprexa what may be the order of sexual side effects? Worst to best.


Desipramine would be much better than nort as far as its side effects go.

Less histamine power, less muscarinic receptor binding and greater ratio between norepinephrine and serotonin.

http://en.wikipedia.org/wiki/Tricyclic_antidepressant#Binding_profiles

Though Alpha 1 is a bit stronger on the desp.

Don't know about lamictal but zyprexa didn't give me any sexual side effects. It's usually the serotonergic drugs that give you sexual side effects. Some people have issues with norepinephrine and erections, but that depends on the person.


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## depressed77 (Dec 9, 2010)

gilmourr said:


> What about desipramine?
> 
> Out of lamictal, nortryptline, desipramine and zyprexa what may be the order of sexual side effects? Worst to best.


Lamictal wouldn't impact on sexual functioning. Nortriptyline would be worst, but still not that bad.

/depressed77


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## gilmourr (Nov 17, 2011)

depressed77 said:


> Lamictal wouldn't impact on sexual functioning. Nortriptyline would be worst, but still not that bad.
> 
> /depressed77


Yeah I was thinking nortrip would because of the alpha 1 antagonism that would affect getting an erection. Would also probably hurt my sex drive. And it's low atm without the abilify now.

Is the NRI function of TCA's the same as SNRI's? Because NRI's usually do a severe number on me making me more depressed. Wellbutrin, nardil, parnate, cymbalta..

But I think I can have just a BIT as long as serotonin is at a greater concentration. I need it for my motivation/concentration and sex drive again.


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## riptide991 (Feb 1, 2012)

gilmourr said:


> Yeah I was thinking nortrip would because of the alpha 1 antagonism that would affect getting an erection. Would also probably hurt my sex drive. And it's low atm without the abilify now.
> 
> Is the NRI function of TCA's the same as SNRI's? Because NRI's usually do a severe number on me making me more depressed. Wellbutrin, nardil, parnate, cymbalta..
> 
> But I think I can have just a BIT as long as serotonin is at a greater concentration. I need it for my motivation/concentration and sex drive again.


TCAs are all alpha 1 agonists not antagonists.

And the NRI function is way more powerful than any SNRI out there. Clomipramine was out of this world strong. It felt like I was on high dose ephedra sinica(not ephedrine hcl) back when it wasn't banned. Definitely had this crazy alertness to it. I've been on 375mg effexor and felt nothing like that from it.


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## gilmourr (Nov 17, 2011)

kehcorpz said:


> Desipramine would be much better than nort as far as its side effects go.
> 
> Less histamine power, less muscarinic receptor binding and greater ratio between norepinephrine and serotonin.
> 
> ...


I think that desipramine might agitate my depression since I'm very certain I have agitated depression/mixed states. I don't think I qualify as BP2. A strong NRI like that will probably make things worse... didn't realize it had such a strong affinity. I think Lamictal gets pushed back since I tried it once and it gave me an allergic reaction. Nortrip seems reasonable, though I like zyprexa because it shouldn't be too strong at a low dose, seems decent side effect wise and I like the 5HT2C and 5Ht6 antagonism + dopamine antagonism might not be that bad at 2.5-5 mg. I'll start at 2.5 though. Lets see if I can get it.


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## depressed77 (Dec 9, 2010)

kehcorpz said:


> TCAs are all alpha 1 agonists not antagonists.
> 
> And the NRI function is way more powerful than any SNRI out there. Clomipramine was out of this world strong. It felt like I was on high dose ephedra sinica(not ephedrine hcl) back when it wasn't banned. Definitely had this crazy alertness to it. I've been on 375mg effexor and felt nothing like that from it.


No, they are antagonists. But I agree on the NRI part, nortriptyline is stronger than clomipramine, so you get the idea.

/depressed77


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## riptide991 (Feb 1, 2012)

depressed77 said:


> No, they are antagonists. But I agree on the NRI part, nortriptyline is stronger than clomipramine, so you get the idea.
> 
> /depressed77


Really, I'm pretty sure when I was researching clomipramine it was an agonist.

And here's wiki from amitriptyline:



> Amitriptyline additionally functions as a 5-HT2A, 5-HT2C, 5-HT3, 5-HT6, 5-HT7, α1-adrenergic, H1, H2,[17] H4,[18][19] and mACh receptor antagonist, *and σ1 receptor agonist.[20][21][22][23]* It has also been shown to be a relatively weak NMDA receptor negative allosteric modulator at the same binding site as phencyclidine.[24] Amitriptyline inhibits sodium channels, L-type calcium channels, and Kv1.1, Kv7.2, and Kv7.3 voltage-gated potassium channels, and therefore acts as a sodium, calcium, and potassium channel blocker as well.[25][26][27]


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## riptide991 (Feb 1, 2012)

lol nevermind that's sigma receptor, looked like an A1 to me.


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## riptide991 (Feb 1, 2012)

Anyways guess it is an antagonist, not sure why i thought otherwise.*shrug* Maybe because of all the research i was doing back then on clonidine which doc suggested I use.


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## depressed77 (Dec 9, 2010)

kehcorpz said:


> Really, I'm pretty sure when I was researching clomipramine it was an agonist.
> 
> And here's wiki from amitriptyline:
> *and σ1 receptor agonist.[20][21]*


That is sigma 

/depressed77


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## gilmourr (Nov 17, 2011)

depressed77 said:


> No, they are antagonists. But I agree on the NRI part, nortriptyline is stronger than clomipramine, so you get the idea.
> 
> /depressed77


Is it actually stronger? The affinity is greater for nortrip for NE, but that's because it has no effect on serotonin really that much presynaptically. I think clomipramine is extremely strong on SERT and NET. If I'm correct, affinity does not mean strength, it means the relationship of the drug affecting certain places presynaptically/post synaptically like a probability. So it's most likely to hit NET, but not as powerfully as clomipramine.


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## riptide991 (Feb 1, 2012)

gilmourr said:


> Is it actually stronger? The affinity is greater for nortrip for NE, but that's because it has no effect on serotonin really that much presynaptically. I think clomipramine is extremely strong on SERT and NET. If I'm correct, affinity does not mean strength, it means the relationship of the drug affecting certain places presynaptically/post synaptically like a probability. So it's most likely to hit NET, but not as powerfully as clomipramine.


Well affinity is how tightly it binds so definitely synonymous with strength. But yah clomipramine itself is weak when it comes to NET but desmethylclomipramine metabolite is super strong. I don't really know the affinity though. I think a large amount of clomipramine turns to desmethylclomipramine so you get a more even feeling. Some people may metabolize more though, I'd say I was one of those people.


----------



## depressed77 (Dec 9, 2010)

gilmourr said:


> Is it actually stronger? The affinity is greater for nortrip for NE, but that's because it has no effect on serotonin really that much presynaptically. I think clomipramine is extremely strong on SERT and NET. If I'm correct, affinity does not mean strength, it means the relationship of the drug affecting certain places presynaptically/post synaptically like a probability. So it's most likely to hit NET, but not as powerfully as clomipramine.


For me it is stronger, no doubt. But as kehcorpz pointed out, the conversion rate to desmethyl-clomipramine will matter a lot. This conversion is sometimes inhibited by adding fluvoxamine, making clomipramine mainly serotonergic.

/depressed77


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## gilmourr (Nov 17, 2011)

kehcorpz said:


> Well affinity is how tightly it binds so definitely synonymous with strength. But yah clomipramine itself is weak when it comes to NET but desmethylclomipramine metabolite is super strong. I don't really know the affinity though. I think a large amount of clomipramine turns to desmethylclomipramine so you get a more even feeling. Some people may metabolize more though, I'd say I was one of those people.


I've been reading this journal and it says that you actually can't really tell the potency of NRI's looking at affinities. You have to look at the pressor response to tyramine which I believe is how well a NET transporter can block a response to tyramine. All desmethylclomipramine, desipramine and nortriptyline have strong responses but I'm fairly certain nortrip is the weakest followed by desmethyl and then desipramine. I'm trying to find TYR30 reports comparing them.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014120/


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## riptide991 (Feb 1, 2012)

gilmourr said:


> I've been reading this journal and it says that you actually can't really tell the potency of NRI's looking at affinities. You have to look at the pressor response to tyramine which I believe is how well a NET transporter can block a response to tyramine. All desmethylclomipramine, desipramine and nortriptyline have strong responses but I'm fairly certain nortrip is the weakest followed by desmethyl and then desipramine. I'm trying to find TYR30 reports comparing them.
> 
> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014120/


I'll save that read for another time, it's long 

Anyways, I'll trust you on this one. Just confused because if nortriptyline is bound to it at a strong affinity, unless it disassociates then nothing else will really interfere. So obviously the transporter wouldn't be available to block anything.


----------



## riptide991 (Feb 1, 2012)

Just skimming through it. So it's just a test to see if the NRI is actually doing what it is supposed to be doing. Well even in your article it shows nortriptyline doing what its affinity states 



> NRIs inhibit tyramine uptake and thus attenuate the response, which gives an in vivo measure of their NRI potency:* indeed the NRIs with the highest affinity for the NAT (reboxetine, desipramine and nortriptyline; Table 3) have all been demonstrated to block this response almost completely*, even when it has been potentiated in the presence of MAOIs


----------



## gilmourr (Nov 17, 2011)

kehcorpz said:


> Just skimming through it. So it's just a test to see if the NRI is actually doing what it is supposed to be doing. Well even in your article it shows nortriptyline doing what its affinity states


Yeah an NRI is supposed to block a response to tyramine. So Parnate + nortrip = no tyramine based reaction.

Nortriptyline should do what it affinity states, I wasn't arguing that; I was arguing that affinity doesn't have a direct relationship with potency. Better affinity doesn't always mean it's more potent. Or at least not for NET inhibitors as cymbalta is almost the same as nortriptyline and I'm pretty sure nortriptyline is more potent.


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## riptide991 (Feb 1, 2012)

gilmourr said:


> Yeah an NRI is supposed to block a response to tyramine. So Parnate + nortrip = no tyramine based reaction.
> 
> Nortriptyline should do what it affinity states, I wasn't arguing that; I was arguing that affinity doesn't have a direct relationship with potency. Better affinity doesn't always mean it's more potent. Or at least not for NET inhibitors as cymbalta is almost the same as nortriptyline and I'm pretty sure nortriptyline is more potent.


Yah, I'm just saying, expect a strong norepinephrine reaction.


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## depressed77 (Dec 9, 2010)

gilmourr said:


> Nortriptyline should do what it affinity states, I wasn't arguing that; I was arguing that affinity doesn't have a direct relationship with potency. Better affinity doesn't always mean it's more potent. Or at least not for NET inhibitors as cymbalta is almost the same as nortriptyline and I'm pretty sure nortriptyline is more potent.


One has to take into account bioavailability, protein binding and the blood brain barrier.

/depressed77


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## riptide991 (Feb 1, 2012)

From wiki to cast my vote for olanzapine! Saphris also blocks 5-ht6 as does clozapine, but clozapine is impossible to get. Saphris is also very strong at blocking D2 receptors. I like olanzapine as it leaves D2 alone at lower doses. Sort of wish I could go back on olanzapine as my cognition hasn't been as good as it has when I was on it. I mean right now it's i'd say kind of normal for me, while olanzapine enhanced it.



> Blockade of central 5-HT6 receptors has been shown to increase glutamatergic and cholinergic neurotransmission in various brain areas,[7][8][9][10] whereas activation enhances GABAergic signaling in a widespread manner.[11] Antagonism of 5-HT6 receptors also facilitates dopamine and norepinephrine release in the frontal cortex,[10][12] while stimulation has the opposite effect.[11]
> 
> Despite the 5-HT6 receptor having a functionally excitatory action, it is largely co-localized with GABAergic neurons and therefore produces an overall inhibition of brain activity.[11] In parallel with this, 5-HT6 antagonists improve cognition, learning, and memory,[13] and agents such as latrepirdine, Lu AE58054, and SB-742,457 are being developed as novel treatments for Alzheimer's disease and other forms of dementia.[10][14][15]


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## gilmourr (Nov 17, 2011)

Yeah Zyprexa atm is higher than nortryptiline because of nortriptylines NRI function that will probably destroy me.

Is Saphris in Canada?

Out of the AP's, Zyprexa and Geodon look the best. I'm trying to find something similar to remeron since remeron kicked *** for depression except I slept for days on it.

Geodon isn't that similar at all, but I like it's partial agonism 5HT1A (might've been why I felt interested/motivated on abilify), the 5HT2A antagonism, 5HT2C antagonism. I don't like 5HT7 antagonized...not sure how that would help...

Zyprexa still looks like the better candidate. 

I just need something that won't kill my sex drive even more because I can't finish having sex and ****...


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## riptide991 (Feb 1, 2012)

gilmourr said:


> Yeah Zyprexa atm is higher than nortryptiline because of nortriptylines NRI function that will probably destroy me.
> 
> Is Saphris in Canada?
> 
> ...


I think Saphris is in Canada but it's only brand name. Either way the D2 antagonism is super strong even at small doses. I don't see zyprexa messing with sex drive since it's a 5-ht2c antagonist. If anything it should enhance it. But then again it's all complicated and everyone is unique.


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## gilmourr (Nov 17, 2011)

Lol, you always have that disclaimer! I'm pretty sure by now I know these meds don't always work like they're supposed to 

Thanks keh


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## gilmourr (Nov 17, 2011)

Felt like **** lately on Abilify, so I stop it, 3 days later, still feel like ****. Exit my system fasterrrrrrrr

I have like 0 energy, I just want to sit around, I'm so tired.

****tiest mood ever.


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## riptide991 (Feb 1, 2012)

gilmourr said:


> Felt like **** lately on Abilify, so I stop it, 3 days later, still feel like ****. Exit my system fasterrrrrrrr
> 
> I have like 0 energy, I just want to sit around, I'm so tired.
> 
> ****tiest mood ever.


Abilify clearance is about 20 days! The metabolite has a 94 hour half life lol.


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## gilmourr (Nov 17, 2011)

kehcorpz said:


> Abilify clearance is about 20 days! The metabolite has a 94 hour half life lol.


It's making me rethink testing out abilify at 5 mg. I was at 2 mg for 24 days...

I wanted to go on zyprexa but maybe I should do 5 mg first and not waste time..


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## A Sense of Purpose (May 8, 2011)

Go for Zyprexa man! I'm a real advocate, only because once it was added to Zoloft, I noticed a dramatic improvement in symptoms within less than a week.


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## gilmourr (Nov 17, 2011)

A Sense of Purpose said:


> Go for Zyprexa man! I'm a real advocate, only because once it was added to Zoloft, I noticed a dramatic improvement in symptoms within less than a week.


I'm sold. Mainly because I feel like crap and this gives me optimism even though it may not work.

I'll start off on 2.5 probably since I'm mixed state/ agitated depression. Wouldn't need 10 since I've never been manic.

Can't get it until Friday...


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## A Sense of Purpose (May 8, 2011)

gilmourr said:


> I'm sold. Mainly because I feel like crap and this gives me optimism even though it may not work.
> 
> I'll start off on 2.5 probably since I'm mixed state/ agitated depression. Wouldn't need 10 since I've never been manic.
> 
> Can't get it until Friday...


5mg is fine to start at.


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## gilmourr (Nov 17, 2011)

Just wondering, but right now I feel super lethargic and bored/uninterested because I'm coming off Abilify. I guess it's because of the dopamine reversing, but anyways...

When I'm on Zoloft I have apathy/motivation/concentration issues, that's it.

If I introduce Zyprexa I'm wondering how it might help that cause. It's receptor affinity (strongest) are 5HT2A, 5HT6, 5HT2B, 5HT2C along with M3 and H1 (all antagonism).

H1 will make me sleep, so I'll take it at night..
5HT2A will help with the residual depression/dysthymia
5HT2B... don't see what this may do (seems like it's for prevention of headaches and cardiovascular issues/serotonin regulation)

5HT2C antagonism will release NE and DA, which is why I'm thinking about taking it. Otherwise it doesn't seem like it will help in any regard.

Do you think 2.5 mg will be enough to hit 5HT2C? Or is 5 a better dose?

Of course this is in theory, but I still like to analyze things to try to pick the best medication as possible.


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## riptide991 (Feb 1, 2012)

I honestly felt a big difference between 2.5mg and 5mg. 5mg really gave me that wow factor.


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## A Sense of Purpose (May 8, 2011)

Do it! OLANZAPINE IS AMAZEBALLS


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## riptide991 (Feb 1, 2012)

Yah and take it about 4-5 hours before bed time! The timing seems important for you to not feel the histamine effect much in the morning since the peak is about 5+ hours.


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## gilmourr (Nov 17, 2011)

kehcorpz said:


> Yah and take it about 4-5 hours before bed time! The timing seems important for you to not feel the histamine effect much in the morning since the peak is about 5+ hours.


Will take note. PLEASE ZYPREXA NO MOOBS


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## riptide991 (Feb 1, 2012)

I don't think you need to worry about moobs on Zyprexa. Since it's usually D2 antagonism that raises PRL significantly.



> The acute and long-term effect of olanzapine compared with placebo and haloperidol on serum prolactin concentrations
> Ann Marie K. CrawfordCorresponding author contact information, Charles M. Beasley Jr., Gary D. Tollefson
> 
> Abstract
> Prolactin elevation is both a common and a persistent event with the currently marketed antipsychotics, excluding clozapine. Elevations have been associated with both acute (galactorrhea, amenorrhea) and chronic (predisposition to osteoporosis) treatment-emergent adverse events. One of the defining criteria for an atypical antipsychotic is the relative lack of persistent prolactinemia. A double-blind, placebo-(N = 68) and haloperidol-(Hal: 15 ±5 mg/day, N = 69) controlled trial of three dose ranges of olanzapine (Olz-L: 5 ±2.5 mg/day, N=65; Olz-M: 10 ±2.5 mg/day, N = 64; Olz-H: 15 ±2.5 mg/day, N = 69) in the treatment of schizophrenia afforded the opportunity to assess the temporal course of the influence of olanzapine and haloperidol on serum prolactin concentration. Consistent with its potent D2 antagonism, haloperidol was associated with a statistically significantly higher incidence of treatment-emergent prolactin elevation (72%) than seen with placebo (8%; p < 0.001) at week 2 of therapy. Expectedly, this elevation was also persistent at weeks 4 and 6. In contrast, olanzapine-associated treatment-emergent prolactin elevations were both lower in magnitude and transient. At week 2, 38% of the Olz-H, 24% of the Olz-M, and 13% of the Olz-L treatment groups exhibited a treatment-emergent prolactin elevation, with a mean increase of 0.35, 0.52, and 0.61 nmol/l, respectively; for haloperidol the mean increase was 1.23 nmol/l. For only the Olz-M and the Olz-H treatment groups did the week 2 incidence of treatment-emergent prolactin elevations differ statistically significantly from placebo. Both the incidence of elevations and the mean increase in prolactin concentration were less than that seen with haloperidol. Furthermore, by treatment week 6, all three olanzapine groups exhibited incidences of treatment-emergent prolactin elevation that were comparable to placebo and were statistically significantly less than observed with haloperidol. Rapid adaptation was observed in the temporal course of prolactin elevations associated with olanzapine based on both the categorical analysis of treatment-emergent high values and the analyses of temporal change in mean concentrations. In contrast to haloperidol, the magnitudes of the treatment-emergent elevations associated with olanzapine were minimal. The rates of elevation were approximately one-half to one-third those observed with haloperidol and were significantly more transient. Olanzapine, even at the highest doses ( 15 ±2.5 mg/day) used, was not associated with persistent elevations of prolactin, consistent with an 'atypical' pharmacologic profile.


Olanzapine increase is smaller than other antipsychotics and it's transient as it disappears at week 6 from above.


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## gilmourr (Nov 17, 2011)

kehcorpz said:


> I don't think you need to worry about moobs on Zyprexa. Since it's usually D2 antagonism that raises PRL significantly.
> 
> Olanzapine increase is smaller than other antipsychotics and it's transient as it disappears at week 6 from above.


Thanks for the reference! This puts my mind at ease.

I'm going to try and get Zyprexa and Prazosin for my daily nightmares caused by Zoloft. Hopefully I get it!


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## gilmourr (Nov 17, 2011)

After a long debate session, I got Zyprexa, but I won't be able to pick any meds after this one or for the next 2 change ups. So hopefully this one works, or I'll probably be put on risperidone then saphris.

Starting at 2.5 mg and moving to 5 mg in a week.

Does anybody know if this will kill my sex drive at a low dose? My sex drive is already fairly low/ability to finish is low, so if Zyprexa works I'm hoping it doesn't steal whatever remaining libido. 

My Pdoc offered cialis if it does work, but I'm not sure I want to be on something like that at my age...

Oh well, lets see what this does.


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## riptide991 (Feb 1, 2012)

Does it matter if people say it will kill your sex drive or not? You're still going to take it. It didn't kill mine but apparently my sex drive is kryptonian and gets its power from the sun.

And I think GotAnxiety took Cialis, I doubt age matters, no one will know but you, the cute pharmacist filling your prescription and your doctor hehe.


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## trymed (Jun 28, 2013)

Ugh.... dude..
You people are junkies. Hahaha. Ahem. :|

Just quit obsessing over drugs... They are not controlling your every move.

And in any case, follow your prescription until a doctor says not to.

Take your meds how you were told, and stop freaking thinking about them.. try to think about your life and what you are taking all those pills for anyways.


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## gilmourr (Nov 17, 2011)

trymed said:


> Ugh.... dude..
> You people are junkies. Hahaha. Ahem. :|
> 
> Just quit obsessing over drugs... They are not controlling your every move.
> ...


Why are you on the medication part of the forum if you don't want to talk about medication? It's not an obsession, it's a valid question as I am seeing someone and can't be completely asexual. Forgetting about your problems doesn't fix them


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## gilmourr (Nov 17, 2011)

kehcorpz said:


> Does it matter if people say it will kill your sex drive or not? You're still going to take it. It didn't kill mine but apparently my sex drive is kryptonian and gets its power from the sun.
> 
> And I think GotAnxiety took Cialis, I doubt age matters, no one will know but you, the cute pharmacist filling your prescription and your doctor hehe.


Oh, I'm for sure going to still take it. Just wanted to know some probabilities of it happening. Hopefully 5HT2C antagonism helps it out rather than kill it.

And you're lucky man.


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## trymed (Jun 28, 2013)

gilmourr said:


> Why are you on the medication part of the forum if you don't want to talk about medication? It's not an obsession, it's a valid question as I am seeing someone and can't be completely asexual. Forgetting about your problems doesn't fix them


Sorry.. just looking thru the new posts.

But I still have a point... and I've been thru all of that... so, yeah.. don't bother being your own psychiatrist, it's not worth it, cause you re not competent. What you are competent in is your life, and there's no point in trying to tweek your meds when you could be living. Take care of your problems however long it takes, and you won't even need most of your pills anymore. Sex won't be a problem, not because of the pills anyways.

Do you have any idea how many variables there are In these calculations? More than half the people you're seeking advice from have or have had psychological problems that have nothing to do with their medications... you really don't need to be taking a neuroleptic or an ssri to feel asexual. 
Let doctors do the doctoring and concentrate on what you're trying to avoid.


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## trymed (Jun 28, 2013)

Mtv is going to take this thread and create a new series called pimp my pills


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## riptide991 (Feb 1, 2012)

trymed said:


> Mtv is going to take this thread and create a new series called pimp my pills


Did you stop taking your antipsychotics again?


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## swim (Apr 4, 2011)

kehcorpz said:


> I honestly felt a big difference between 2.5mg and 5mg. *5mg really gave me that wow factor*.


What do you mean? Does olanzapine wipe away guilt and intrusive thoughts? Btw I can't afford it as I'm already heavy-set and close to the 40s, the adverse effects would wreck me.


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## Konami (Jul 5, 2011)

swim said:


> Does olanzapine wipe away guilt and intrusive thoughts?


good question. I`d like to hear the answer too.


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## riptide991 (Feb 1, 2012)

swim said:


> What do you mean? Does olanzapine wipe away guilt and intrusive thoughts? Btw I can't afford it as I'm already heavy-set and close to the 40s, the adverse effects would wreck me.


Well I don't know about guilt as I never really felt any but definitely helps intrusive thoughts. The wow factor was just it made me feel so much like myself at the time combined with the 375mg effexor. It actually helped remove a lot of my anhedonia.


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## trymed (Jun 28, 2013)

kehcorpz said:


> Did you stop taking your antipsychotics again?


I stopped taking them in 2006.  I have a semi normal life, a good job, two kids, a dog, a cat.. blah blah. Nothing worth bragging about, but if I had known years ago What I know now... I would have suffered a lot less.


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## trymed (Jun 28, 2013)

Cigarettes.. yum.
You know how you smoke when you're stressed out? 
And how nice it is to smoke when you're relaxed?
Why is that? That you smoke too calm down.. and then you smoke for the opposite reason because you're nice and calm. ?. 
Because your mood has nothing to do with it, you're just acting like an addict and smoking whenever you can.

Meds are similar. Trying not to get caught up in that addictive behavior is important if you actually want results from what you do to lead a better life. I really hope some one out there understands this. 
Worry about your meds when your with your psychiatrist, and then just don't think about it.. get out and live.


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## GotAnxiety (Oct 14, 2011)

Just for the record I've never really had a problem getting it up. It was just what it seem's to be lack of ejaculate and orgasm. Sexual dissatisfaction it like sperm transportation doesn't work properly. Seroquel some how improved this I was binge drinking hard and taking seroquel everynight then I had the opposite of this problem one day where every ejaculation got bigger and bigger each time it was weird I got this pressure in the pelvis and my loads actually shot for that one night. What a mess lol. But normally I don't get that pressure/ buildup in the pelvic region and it doesn't shoot. It like sperm not going to the place it needs to be ejaculated from. So I dunno what causes this something to do with serotonin and alpha recepter i imagine. I wonder if an alpha blocker would help cause seroquel kinda did but it has other properties that may cause a more disadvantage.

I never had these problems befor ssri or smoking I think lol it been so long. But only 1.5 orgasms my whole life. I still masterbate like 3 times a day. I just wish the end result was better.


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## riptide991 (Feb 1, 2012)

trymed said:


> I stopped taking them in 2006.  I have a semi normal life, a good job, two kids, a dog, a cat.. blah blah. Nothing worth bragging about, but if I had known years ago What I know now... I would have suffered a lot less.


What if you don't eh? Wouldn't that be trippy? You got off your antipsychotic and all of a sudden a family appeared and a job and stuff.



GotAnxiety said:


> I still masterbate like 3 times a day. I just wish the end result was better.


Have you tried wearing swimming goggles?


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## trymed (Jun 28, 2013)

kehcorpz said:


> What if you don't eh? Wouldn't that be trippy? You got off your antipsychotic and all of a sudden a family appeared and a job and stuff.
> 
> Have you tried wearing swimming goggles?


ok.. now try criticizing me for calling you people junkies. Hehehe


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## riptide991 (Feb 1, 2012)

trymed said:


> ok.. now try criticizing me for calling you people junkies. Hehehe


I don't need to criticize you. Unlike you who is trying to force his own view on others, I don't do that sort of thing. You can do what you want and i'll do what I want.


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## trymed (Jun 28, 2013)

kehcorpz said:


> I don't need to criticize you. Unlike you who is trying to force his own view on others, I don't do that sort of thing. You can do what you want and i'll do what I want.


 What views? Who wants to make you do anything? 
You think that me commenting on your desire to coerce your psychiatrist into giving you the drugs that YOU want and not those prescribed is a way of forcing my views on to you and making you do things? That's a bit on the defensive.

Any ways, whatever.


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## gilmourr (Nov 17, 2011)

trymed said:


> What views? Who wants to make you do anything?
> You think that me commenting on your desire to coerce your psychiatrist into giving you the drugs that YOU want and not those prescribed is a way of forcing my views on to you and making you do things? That's a bit on the defensive.
> 
> Any ways, whatever.


Like stated before... this is a medication sub forum. If you don't want to add anything regarding using medications then you shouldn't be posting here; Not because you're not allowed but because it isn't relevant. You're just deterring the conversation. Medications have allowed many people here to live their lives or at least get it to a point where they aren't in hell.


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## trymed (Jun 28, 2013)

gilmourr said:


> Like stated before... this is a medication sub forum. If you don't want to add anything regarding using medications then you shouldn't be posting here; Not because you're not allowed but because it isn't relevant. You're just deterring the conversation. Medications have allowed many people here to live their lives or at least get it to a point where they aren't in hell.


I probably just added the most relevant point regarding the usage, or abuse, of medication in this thread. The only problem is that it's triggering a violent defence mechanism.

There aren't many professionally organised support groups created to allow for psychiatric patients to get together and discuss how they can pimp their prescriptions with little or no professional guidance. Think about it.


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