# antidepressants that do not cause anhedonia, apathy, indifference, amotivation



## Hordak (May 5, 2017)

*antidepressants that do not cause anhedonia, apathy, indifference, amotivation, sexual problems*

Let's talk about antidepressants that do not cause the aforementioned side effects. Many patients on SSRIs & SSNRIs witness side effects that share some similarities with core-symptoms of depression.

https://www.ncbi.nlm.nih.gov/pubmed/22410206

informative reading-material:
ANHEDONIA - Questions and Answers
https://www.depressionforums.org/fo...essapathy-no-1/?do=findComment&comment=923186
Answers To Curing Anhedonia/numbness/apathy, No. 2



Gillman fan said:


> I feel like going on a rant re: SSRIs but usually when these threads are migrated from another forum the original posters disappear.
> 
> Your doctor has plenty of other options for antidepressants that do not cause sexual dysfunction and apathy, as well as medications that can ameliorate these side effects. The "accepted wisdom" among doctors seems to be that the serious long term side effects of apathy and sexual dysfunction are not a problem. The best thing you can do as a patient is point out how serious these side effects are and demand that your doctor discuss alternatives you have researched.
> 
> http://www.socialanxietysupport.com/forum/1089527121-post25.html


hello to you all :smile2:

because of depression (Dystymia with reoccurring episodes of MDD) and a specific social anxiety (glossophobia | speech anxiety), I've been taking Sertraline 50mg for 8 weeks now...

I've started with 12,5mg for 3 days, then went up to 25mg for 7 days and finally upped to 50mg. Since I am on 50mg, I am dealing with some very "annoying" side effects:

# insomnia (falling asleep is difficult, shallow sleep, waking up a lot in the night... to my surprise I am not sleepy during daytime, but somewhat "stoned" and dazed.
# flat emotions, emotional dullness / blunting, apathy, anhedonia, indifference (it's like being a Vulcan or a Borg drone).
# loss of libido / no sex drive: I have no problem getting "him" hard, but there is no joy in it anymore. It's like being prepubescent.​
It took away everything human from me, everything that it's worth living for. Sleeping, sex, joy, motivations and emotions are the basic things of human existence, see Maslow's hierarchy of needs. I'd rather be depressive and anxious than how I am right now...

Are there antidepressants, that help with depression and social anxiety, but do not cause the zombification & sexual problems? And what are these?

Greetings from Germany,
Duckbruck


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## Gillman fan (Sep 24, 2016)

You didn't say how severe your symptoms are when you are depressed, but it doesn't really matter. Double depression - acute depressions interspersed with dysthymia, is much harder to treat than the mild depressions that fill clinical trials. I don't think you are going to get much mileage out of mediocre treatments like SSRIs.

Dysthymia is actually very hard to treat. Acute depressions are when your brain is out of whack, so you just need a little boost in order to return to a "normal" state. The problem is that dysthymia is "normal" for your brain. It is very difficult to change this homeostasis.

The real dilemma here isn't your medication options. There are plenty of potent drugs out there. The issue is that psychiatrists don't want to prescribe them. Maybe he will suggest adding something like Wellbutrin and I am sure your psychiatrist would be OK with Remeron. But these are not particularly potent drugs. IMO, based on research I have done, you need to be aggressive and pursue a full remission. The longer depression goes untreated, the worst the prognosis. It becomes more difficult to get a medication response. You do have some options with potent drugs but I am not going to go into full detail here. Just look at my signature - I am lucky to have a psychiatrist who listens to my suggestions and has prescribed a number of "unusual" drugs for me, it took a lot but I am finally in remission.

So your doctor is probably unwilling to prescribe the meds powerful enough to give you full remission. They are completely accustomed to working with SSRIs, antipsychotics and a few other drugs.

Mirtazepine is a good compromise, probably as good as you are going to get from your doctor now, and it won't give you those unwanted side effects. Neither will Wellbutrin. It should be easy enough to get a prescription for either or both of these drugs. Doctors love to switch from one SSRI to another, but it is very likely if you experience nasty side effects on one SSRI you will experience the same problems on another SSRI.

I am on an MAOI which is popular on these forums, I don't want to go into much more detail but read around here for testimonials. MAOIs are powerful drugs, and Parnate especially produces remarkably few side effects. I have insomnia, that is it. .

Oh and if Cara Delevigne jumps you but you don't feel into her, send her my way


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## Hordak (May 5, 2017)

Gillman fan said:


> You didn't say how severe your symptoms are when you are depressed


My dystymia is characterized mostly by mild/moderate anhedonia, difficulty making decisions and lack of motivation. It is some sort auf agitated dystymia with much restlessness. I have to say that the psychomotor agitation is the worst part about it... I would like to calm down and not be psychotic hamster ^^

I had two acute depressions, but those were mostly reactive to difficult life circumstances.

I am not suicidal and I never was.



Gillman fan said:


> Dysthymia is actually very hard to treat. Acute depressions are when your brain is out of whack, so you just need a little boost in order to return to a "normal" state. The problem is that dysthymia is "normal" for your brain. It is very difficult to change this homeostasis.


I have found out for myself that an organized and strict lifestyle (sleep hygiene, exercise, regular relaxation, eating habbits) has very positive effects on my Dystymia, but it doesn't lead to full remission. That's why I am trying also ADs and psychotherapy etc.



Gillman fan said:


> The real dilemma here isn't your medication options. There are plenty of potent drugs out there. The issue is that psychiatrists don't want to prescribe them.
> 
> IMO, based on research I have done, you need to be aggressive and pursue a full remission.
> 
> So your doctor is probably unwilling to prescribe the meds powerful enough to give you full remission. They are completely accustomed to working with SSRIs, antipsychotics and a few other drugs.


I agree. Especially in Germany they are very strict and overcautious when it comes to anti depressants and psychopharmacology. They mostly prescribe SSRIs.

Here are some stats on German prescriptions: http://www.mind-and-brain-blog.de/en/576/drug-prescription-report-2012-antidepressants/



Gillman fan said:


> Mirtazepine is a good compromise, probably as good as you are going to get from your doctor now, and it won't give you those unwanted side effects. Neither will Wellbutrin. It should be easy enough to get a prescription for either or both of these drugs.


Indeed!
I was also thinking about some synergetic combos, for example Venlafaxine + Mirtazapine or a SSRI + Mirtazapine. But I definitely need something that stimulates my appetite & and helps with my sleep & agitation... Mirtazapine seems to be a promising candidate :con



> Mirtazapine in combination with an SSRI, SNRI, or TCA as an augmentation strategy is considered to be relatively safe and is often employed therapeutically,[47][77][78][79][80] with a combination of venlafaxine and mirtazapine sometimes referred to as "California rocket fuel".[81]
> 
> https://en.wikipedia.org/wiki/Mirtazapine#Interactions





> Antagonism of the 5-HT3 receptor, an action mirtazapine shares with the approved antiemetic ondansetron, significantly improves pre-existing symptoms of nausea, vomiting, diarrhea, and irritable bowel syndrome in afflicted individuals.[110] Mirtazapine may be used as an inexpensive antiemetic alternative to ondansetron.[26] Blockade of the 5-HT3 receptors has also shown to improve anxiety and to be effective in the treatment of drug addiction in several studies.[111] In conjunction with substance abuse counseling, mirtazapine has been investigated for the purpose of reducing methamphetamine use in dependent individuals with success.[105] In contrast to mirtazapine, the SSRIs, SNRIs, MAOIs, and some TCAs increase the general activity of the 5-HT2A, 5-HT2C, and 5-HT3 receptors leading to a host of negative changes and side effects, the most prominent of which including anorexia, insomnia, sexual dysfunction (loss of libido and anorgasmia), nausea, and diarrhoea, among others. As a result, it is often combined with these drugs to reduce their side-effect profile and to produce a stronger antidepressant effect.[47][77][78][79][80][112]
> 
> Like many other antidepressants, mirtazapine has been found to have antinociceptive properties in mice.[114] However, unlike most other antidepressants, though similarly to venlafaxine, these effects are mostly mediated through downstream modulation of the endogenous opioid system, of which in the case of mirtazapine the μ opioid and κ3 opioid receptors are mainly involved.[114] Interestingly, while virtually all antidepressants differ little in their maximal effectiveness in the treatment of major depression, mirtazapine and venlafaxine have demonstrated superior efficacy in treating severe types of depression such as psychotic depression and treatment-resistant depression.[114] This may be due to their unique influence on the opioid system, which is a property that may give them an advantage over other antidepressants in cases of severe depressive symptomatology.[114]
> 
> https://en.wikipedia.org/wiki/Mirtazapine#Correspondence_to_clinical_effects





> A comparative meta-analysis of 12 major antidepressants found that venlafaxine, mirtazapine, escitalopram, and sertraline were significantly more efficacious than duloxetine, fluoxetine, fluvoxamine, paroxetine, and reboxetine.[8] A combination of venlafaxine and mirtazapine achieved remission rates (defined as a HAM-D score of 7 or less) of 58% in one controlled trial.[9] In combination with an antipsychotic medicine aripiprazole, better results in treatment resistant depression in older adults have been demonstrated.[10]
> 
> https://en.wikipedia.org/wiki/Venlafaxine





Gillman fan said:


> Doctors love to switch from one SSRI to another, but it is very likely if you experience nasty side effects on one SSRI you will experience the same problems on another SSRI.


Yes, that's what I am afraid of. Doctors here like to cycle SSRIs and waste the life-time of their patients...



Gillman fan said:


> I am on an MAOI which is popular on these forums, I don't want to go into much more detail but read around here for testimonials. MAOIs are powerful drugs, and Parnate especially produces remarkably few side effects. I have insomnia, that is it. .


To get a MAOI prescribed in Germany, I would have to lay down onto the track bed and wait for the train to cut my head off :lol:troll
They'd rather prescribe me electro-convulsive therapy than MAOI :um



Gillman fan said:


> Oh and if Cara Delevigne jumps you but you don't feel into her, send her my way


Unlikely, but I will keep that in mind :grin2::boogie


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## Hordak (May 5, 2017)

My libido / sex drive has become better for the last two days.

Additionally to my other side effects I've been having headaches, upset stomach and hot flashes for the last 3 days.

I'll give the Sertraline 3 more weeks and see what happens 
I'll let you know in three weeks how it went...


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## Hordak (May 5, 2017)

I have the feeling that Sertraline is worsening my agitation & restlessness. I am sitting on my chair and whipping around


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## Gillman fan (Sep 24, 2016)

Duckbruck: Agitation and restlessness is one symptom that is "supposed" to get better as 5ht2a downregulates. SSRIs are a terrible treatment for some of your other symptoms though, e.g. anhedonia. Receptor 5ht2c does not downregulate, it is pretty strongly linked to anhedonic symptoms. It is a very common long term side effect for people who did not have it in the first place, let alone people who start out with that symptom.

Given this, you should try to get a Mirtazepine Rx and see how it does for your anhedonic symptoms. SSRIs tend to be more relaxing, feel good, and anxiolytic once they "kick in" over time but apathy is a side effect that usually remains. Re: the scholarly articles you linked, much of the praise regarding Mirtazepine applies equally to any med that is NOT an SSRI, e.g. most tricyclics are quite weak on serotonin. Anyway it is worth a shot. SSRI + Mirtazepine is usually better than just SSRI if you experience anhedonia. My view of Mirtazepine is overall not that great, but since most patients are forced on SSRIs, it can help to lessen the blow.

However, if you want to start afresh - I had a look at the statistics re: German prescribing and I was surprised to see tricyclics doing so well. It looks like Amitryptiline is commonly prescribed in Germany. This med is interesting for several reasons, it offers several rather unconventional mechanisms for curing depression, and it metabolizes into Nortriptyline, which is a great 5ht2a and 5ht2c antagonist, just a great med period. It is rather like having 2 medications for the price of one. I don't think it would worsen anhedonia. Moderately strong on antihistamine, it should be a sedating combo which may help with your agitation. Anticholinergic side effects may bother you, or they may not, but at least it won't make your preexisting symptoms worse.

Probably the worse thing about tricyclics is that there is a significant statistical link between anticholinergics and dementia. But for you at age 27 I wouldn't worry about this too much. If a TCA treats your symptoms well but the anticholinergic effects really bother you, there are ways of treating those side effects as well.

Edit: here is another page on these forums re: medication combos. http://www.socialanxietysupport.com/forum/f30/let-s-talk-ultimate-medication-combos-1884785/
I forgot STAR * D. This was the biggest controlled trial of multiple medications. Effexor + Mirtazepine was compared directly to Parnate. They showed up equal - but this was at an inadequate dose of Parnate (39 mg average). The study authors admitted as much in follow up commentary on the study.


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## cigpk (May 8, 2017)

Duckbruck said:


> My libido / sex drive has become better for the last two days.
> 
> Additionally to my other side effects I've been having headaches, upset stomach and hot flashes for the last 3 days.
> 
> ...


I'm one week in on adding 50 mg zoloft to my 300mg wellbutrin and 30mg buspirone.

Keep us posted on if the libido/sex drive returns... I have basically the same exact issue as you mentioned above with no interest in it whatsoever...however it has gotten slightly better since day 2-3. My appetite is nonexistant and i feel nauseous all day long too.


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## alchemist1 (May 8, 2017)

Milnacipran is a SNRI which blocks the reuptake of serotonin and norepinephrine almost equally. So it's much more potent on the norepinephrine reuptake than duloxetine (Cymbalta) and venflaxaine (Effexor). As far as I know, milnacipran is only approved for fibromyalgia in the States, but here in Europe it's also prescribed against depression and anxiety (like "normal" SSRIs/SNRIs). And OH BOY, does it work! For the first time in my life, or perhaps at least in the last few years, I feel CALM. I've been taking 50 mg per day (most people are recommended to take 100) and I have experienced very mild sexual side effects (which is kind of good for me, because I used to be overly sexual to the point it was frustrating). I have no problems achieving and maintaing an erection, but the orgams (which are no problem too) do feel a little bit toned down, maybe like 10-20 % less pleasurable. But all in all, nothing major as far as sexual side effects are concerned. 

In the first few days, I experienced some headaches, but they were gone after a few days. The only lasting side effect was a very unpleasant sleep maintenance insomnia, for which I now take about 100 mg trazodone. Now sleep's perfect again.


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## Hordak (May 5, 2017)

I regained my libido /sex drive to some degree, so that's on the positive side.
That unpleasant "cocaine feeling" has also subsided.

What remains negative: 
# insomnia 
# no appetite | upset stomach | gastric malaise
# agitation
# anhedonia to some degree...



Gillman fan said:


> Given this, you should try to get a Mirtazepine Rx and see how it does for your anhedonic symptoms. SSRIs tend to be more relaxing, feel good, and anxiolytic once they "kick in" over time but apathy is a side effect that usually remains.
> 
> Re: the scholarly articles you linked, much of the praise regarding Mirtazepine applies equally to any med that is NOT an SSRI, e.g. most tricyclics are quite weak on serotonin. Anyway it is worth a shot. SSRI + Mirtazepine is usually better than just SSRI if you experience anhedonia. My view of Mirtazepine is overall not that great, but since most patients are forced on SSRIs, it can help to lessen the blow.


I think that is the best and most realistic option for me. Getting Mirtazapine prescribed should be relatively easy.

Does Trazodone also have antiemetic and appetite stimulating properties?

And what is your opinion on Maprotiline?



Gillman fan said:


> However, if you want to start afresh - I had a look at the statistics re: German prescribing and I was surprised to see tricyclics doing so well. It looks like Amitryptiline is commonly prescribed in Germany. This med is interesting for several reasons, it offers several rather unconventional mechanisms for curing depression, and it metabolizes into Nortriptyline, which is a great 5ht2a and 5ht2c antagonist, just a great med period. It is rather like having 2 medications for the price of one. I don't think it would worsen anhedonia. Moderately strong on antihistamine, it should be a sedating combo which may help with your agitation. Anticholinergic side effects may bother you, or they may not, but at least it won't make your preexisting symptoms worse.


German inpatients _(hospitals, psychiatric day clinics etc.)_ most often get prescribed TCAs.
Ambulant patients and GP-visitors most often are put on SSRIs and SNRIs.

That's the german psychiatric duality.

But I agree wit you. A TCA like Amitryptiline (Nortriptyline) or maybe even Clomipramine (?) would be worth a try. I will have to talk it over with my psychiatrist. This is always the difficult part, the fine line between being an patient and a "smartass". 8) Many doctors are very allergic to suggestions from their patients ^^



Gillman fan said:


> Edit: here is another page on these forums re: medication combos. http://www.socialanxietysupport.com/forum/f30/let-s-talk-ultimate-medication-combos-1884785/


Thank you.
That is indeed an interesting combo. I've been doing some reading and all about it sounds very promising.

Been checking our pharmacies: We have Nortrilen 10mg in Germany.
https://www.medizinfuchs.de/preisve...ees-10-mg-50-st-lundbeck-gmbh-pzn-730081.html



Gillman fan said:


> I forgot STAR * D. This was the biggest controlled trial of multiple medications. Effexor + Mirtazepine was compared directly to Parnate. They showed up equal - but this was at an inadequate dose of Parnate (39 mg average). The study authors admitted as much in follow up commentary on the study.


We do have Tranylcypromin (Parnate) in Germany, but it's really expensive:
https://www.medizinfuchs.de/wirksto...ons][packages][]=100+ST&params[filter_price]=

https://www.medizinfuchs.de/wirksto...ions][packages][]=50+ST&params[filter_price]=

We don't have Phenelzin (Nardil) in Germany.


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## Hordak (May 5, 2017)

cigpk said:


> I'm one week in on adding 50 mg zoloft to my 300mg wellbutrin and 30mg buspirone.


That's one potent hellraiser mix :O:grin2:



cigpk said:


> Keep us posted on if the libido/sex drive returns...


I will... 



cigpk said:


> I have basically the same exact issue as you mentioned above with no interest in it whatsoever...however it has gotten slightly better since day 2-3. *My appetite is nonexistant and i feel nauseous all day long too.*


A problem shared is a problem halved :hug

How is your sleep?


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## Gillman fan (Sep 24, 2016)

Re: Nortriline and Maptroline - for the most part when I post here on the forums I am relying on reading I did months ago, studies, patient reviews etc. that basically just included meds in the US. I can read the Wikipedia pages for this two but it tends to not be very helpful. Also no receptor affinity data, which I consider very important.

You might have been asking Alchemist but I take Trazodone too. The big thing about Trazodone for me is that it does not build any tolerance, it does not cause withdrawals, it is non-addictive etc. And it can be a very potent sleep med. Almost all other sleep meds rely on antihistamine activity for a big part of their action, this tends to build tolerance over time.

Trazodone is a sleep med that moderately agonizes 5ht1a which I basically think of as the "MDMA" receptor, because agonizing it feels the most like MDMA /ecstasy. It is strongest at antagonizing 5ht2a which is anti-anxiety, sleep-inducing, and also feels good. Moderate antagonist at 5ht2c which may help with anhedonia. It it moderately antagonizes some adrenal receptors which helps your body to calm down. Moderately antagonizes histamine receptors which acts as a sedative. At higher doses it has some SSRI action, significantly higher doses than sleep aid dosage.

It isn't in your blood stream all day so it isn't going to do TOO much during the day. For me it is a sleep med but it also feels great. No effect on appetite or nausea. The weirdest thing about Trazodone is that it significantly boosts your erections! In extreme and unusual cases it can cause an erection that lasts 4+ hours which generally requires ER visit.


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## cigpk (May 8, 2017)

Duckbruck said:


> That's one potent hellraiser mix :O:grin2:
> 
> I will...
> 
> ...


Yep today marked one week at 50 mg (I was told to start at 25 and then double it in 4 days or so but I figured I mine as well just work through any start-up effects now and get them over with). I'm feeling a lot better today then I have been and I have noticed my libido returning over the past few days which I'm relieved about.

Sleep is actually not all that bad. I am transitioning from remeron to zoloft and for me, remeron is more sedating as I lower my dose. I have one more night at 7.5 mg (I was at 30 mg initially) and then I will be halving that to 3.25 mg.


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## Hordak (May 5, 2017)

cigpk said:


> Yep today marked one week at 50 mg (I was told to start at 25 and then double it in 4 days or so but I figured I mine as well just work through any start-up effects now and get them over with). I'm feeling a lot better today then I have been and I have noticed my libido returning over the past few days which I'm relieved about.
> 
> Sleep is actually not all that bad. I am transitioning from remeron to zoloft and for me, remeron is more sedating as I lower my dose. I have one more night at 7.5 mg *(I was at 30 mg initially)* and then I will be halving that to 3.25 mg.


How was it for you to be on 30mg of Remeron? Were you always sleepy, weak and lethargic?
And why are you switching over?


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## cigpk (May 8, 2017)

When I was at 15 mg I was sleepy a good bit. It would knock me out pretty easily too. 

When I got to 30 mg I was fine. I actually felt reeeally good honestly. That feeling of when you get a rush and your hair stands up on your neck - I would have that sort of feeling all the time when I heard a good song or thought about something meaningful. I actually loved remeron and I may go back to it at some point but my primary reason for taking an antidepressant is my OCD which then results in SA, GAD and MDD (which remeron was good for anxiety and depression). Remeron is not very helpful for OCD in my experience so I got back on an SSRI.

My worry with Zoloft is that SSRIs are supposed to be much better for OCD at higher doses, so I'm hoping I won't have to go too high on the zoloft. I'm thinking 75 mg MAX, maybe 100 if it doesn't see any results below that.

And about the Remeron - it made my libido through the roof honestly. I know it can help with SSRI-induced sexual dysfunction but it was at an all time high on my combo of wellbutrin, buspar, and remeron (i think all 3 have the potential to boost libido).


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## cigpk (May 8, 2017)

Duckbruck said:


> How was it for you to be on 30mg of Remeron? Were you always sleepy, weak and lethargic?
> And why are you switching over?


also to explain the sleepiness at a lower dose - I believe it's because lower doses of Remeron (7.5 - 15mg) work more on the histamine receptors while higher doses of 30 mg or 45 mg are activating - work more on the noradrenergic receptors.


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## Hordak (May 5, 2017)

Gillman fan said:


> You might have been asking Alchemist but I take Trazodone too. The big thing about Trazodone for me is that it does not build any tolerance, it does not cause withdrawals, it is non-addictive etc. And it can be a very potent sleep med. Almost all other sleep meds rely on antihistamine activity for a big part of their action, this tends to build tolerance over time.
> 
> Trazodone is a sleep med that moderately agonizes 5ht1a which I basically think of as the "MDMA" receptor, because agonizing it feels the most like MDMA /ecstasy. It is strongest at antagonizing 5ht2a which is anti-anxiety, sleep-inducing, and also feels good. Moderate antagonist at 5ht2c which may help with anhedonia. It it moderately antagonizes some adrenal receptors which helps your body to calm down. Moderately antagonizes histamine receptors which acts as a sedative. At higher doses it has some SSRI action, significantly higher doses than sleep aid dosage.
> 
> It isn't in your blood stream all day so it isn't going to do TOO much during the day. For me it is a sleep med but it also feels great. No effect on appetite or nausea. The weirdest thing about Trazodone is that it significantly boosts your erections! In extreme and unusual cases it can cause an erection that lasts 4+ hours which generally requires ER visit.


:thanks

I will keep that in mind.
I am very curious as to what my psychiatrist will suggest...

I am on vacation as off tomorrow morning, so I wish you a nice weekend. I will post something new :drunk:spitnext week...


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## Hordak (May 5, 2017)

cigpk said:


> When I was at 15 mg I was sleepy a good bit. It would knock me out pretty easily too.
> 
> When I got to 30 mg I was fine. I actually felt reeeally good honestly. That feeling of when you get a rush and your hair stands up on your neck - I would have that sort of feeling all the time when I heard a good song or thought about something meaningful. I actually loved remeron and I may go back to it at some point but my primary reason for taking an antidepressant is my OCD which then results in SA, GAD and MDD (which remeron was good for anxiety and depression). Remeron is not very helpful for OCD in my experience so I got back on an SSRI.


Thank you for your explanation.
I think I will give it a try (hopefully my psychiatrist will prescribe it to me).
I need something that puts me on a normal sleep cycle with much restful sleep (and gives me appetite ^^)

Either that or alternatively Trazodone.



cigpk said:


> My worry with Zoloft is that SSRIs are supposed to be much better for OCD at higher doses, so I'm hoping I won't have to go too high on the zoloft. I'm thinking 75 mg MAX, maybe 100 if it doesn't see any results below that.


That's my worry too.
For most people 50mg are not enough, so upping it to 100mg may be necessary :afr:troll



cigpk said:


> And about the Remeron - it made my libido through the roof honestly. I know it can help with SSRI-induced sexual dysfunction but it was at an all time high on my combo of wellbutrin, buspar, and remeron (i think all 3 have the potential to boost libido).


I hope your female friend / wife enjoyed it :cig :cup :banana


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## cigpk (May 8, 2017)

Duckbruck said:


> Thank you for your explanation.
> I think I will give it a try (hopefully my psychiatrist will prescribe it to me).
> I need something that puts me on a normal sleep cycle with much restful sleep (and gives me appetite ^^)
> 
> ...


haha funny you should say that actually. My gf is on 150 mg of zoloft so her sex drive is relatively nonexistant. Which I must say is making this whole process easier on me because she can relate (and we've been through this process before - 20 mg lex knocked out my drive for a while).

I figure if 50 mg helps but not enough, I'll do a test run on 75 mg before moving up to 100 mg.


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## Hordak (May 5, 2017)

All my wisdom teeth are finally out. :boogie
And I am feeling already better *lol* ^^



cigpk said:


> haha funny you should say that actually.


Sorry :squeeze



cigpk said:


> My gf is on 150 mg of zoloft so her sex drive is relatively nonexistant. Which I must say is making this whole process easier on me because she can relate (and we've been through this process before - 20 mg lex knocked out my drive for a while).


reminds me of this:


> _BTW, when my girlfriend and I were both on Zoloft, sex was a little weird. We would go for a few hours until we were both finally like "All right this is ridiculous, let's watch TV instead." But, it was still fun - it helps when you have a partner with a sense of humor. _
> 
> http://www.socialanxietysupport.com/forum/f30/sexual-side-effects-on-50mg-zoloft-112590/#post1793452





cigpk said:


> *I figure if 50 mg helps but not enough, I'll do a test run on 75 mg before moving up to 100 mg.*


I have come to the same conclusion.
It definitely has some positive effects on me, but for "full" effect I will have to go up @75mg oder maybe even @100mg.


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## sad1231234 (Jul 10, 2016)

They can have those negative side effects.


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## Laedus (May 17, 2017)

The only drug didn't break my dick was Mirtazapine. In fact, it can increase pleasure and libido. However, you will gain a lot of weight and it will make you quit like me and then you're back to square one. I cannot stay on the drug because I gain too much wait. 

I am 5'8" naturally about 155 lbs but on medication easily 175 within 2 months of mirtazapine. You will be HUNGRY (as hungry as consuming cannabis), and you WILL gain weight. At least on cannabis you don't gain wait. So I think there is also a receptor that is causing weight gain. It's not just the calories in calories out. But you will feel great. 

I might get back on myself. I'm currently in really bad shape anxiety wise and Mirtazapine is good for that. However, a wedding in less than a year I don't want to show up like the Michelin man.


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## Laedus (May 17, 2017)

We can't edit posts? Okay lol.

I will add that if you go on Mirtazapine you need to quit alcohol. It is a very very bad combination. If you're not prepared to quit alcohol don't bother.


----------



## cigpk (May 8, 2017)

I was also on Wellbutrin when I took Mirtazepine and weight gain was not an issue at all. BUT the norm is definitely that people gain weight on it.

I can't speak to the alcohol part as I am now sober but that would make sense as well.


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## Hordak (May 5, 2017)

I've had an appointment with my psychiatrist and we agreed on that I will take 50mg of Sertraline for another month or so and if the side effects (mainy insomnia and appetite loss) haven't subsided by then, we will try augmenting it with either Mirtazapine or Trazodone or alternatively try another standalone med...



Laedus said:


> The only drug didn't break my dick was Mirtazapine.


Did it help you with your depression / SA? And how was it compared to other ADs?



Laedus said:


> I will add that if you go on Mirtazapine you need to quit alcohol.


That's no problem for me. I am no alcohol-guy ^^


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## Laedus (May 17, 2017)

Duckbruck said:


> I've had an appointment with my psychiatrist and we agreed on that I will take 50mg of Sertraline for another month or so and if the side effects (mainy insomnia and appetite loss) haven't subsided by then, we will try augmenting it with either Mirtazapine or Trazodone or alternatively try another standalone med...
> 
> Did it help you with your depression / SA? And how was it compared to other ADs?
> 
> That's no problem for me. I am no alcohol-guy ^^


It worked far better than any SSRI for anxiety - definitely. Although the happiest drug I've used was probably Paxil or one of those horrible drugs that makes your dick stop working. They are really good at pumping serotinin into your brain but bad at everything else.

It's been a while since I've used it. I think I mostly came off because of the weight gain and similar side effects. Then when I tried to get back on they didn't work as well. I might try again if this St. Johns Wort doesn't work.

I'm just very sensitive about weight and health and the Mirtazapine was making me constantly hungry and fat so I came off. It also might have been pooping out. I can't remember. Been a few years and a bad memory. This drug does have a high poop out rate as well.


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## Hordak (May 5, 2017)

Laedus said:


> It worked far better than any SSRI for anxiety - definitely.


:yes

At what dosage where you on it?



Laedus said:


> This drug does have a high poop out rate as well.


That's the problem with Mirtazapine. I've read a lot about Mirtazapine pooping out...


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## Hordak (May 5, 2017)

I am beginning to like that Setraline stuff 
self-confidence is at an all time high, even been impulsive the last few days and positively aggressive. 

nonetheless, lack of appetite and moderate insomnia is still a problem. (61kg @ 5'9'')
EDIT: And I am a little bit agitated, whipping up and down on my chair ^^


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## Hordak (May 5, 2017)

Is the "feverish" feeling a normal side effect under Sertraline? It coincides with my hot flashes... it makes me feel somewhat sick.


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## Hordak (May 5, 2017)

Gillman fan said:


> Re: Nortriline and Maptroline - for the most part when I post here on the forums I am relying on reading I did months ago, studies, patient reviews etc. that basically just included meds in the US. I can read the Wikipedia pages for this two but it tends to not be very helpful. *Also no receptor affinity data, which I consider very important.*


I've been searching and searching and searching and finally have found something ... 
https://www.researchgate.net/profil...ities-of-Antidepressants-A-Novel-Approach.pdf
https://dspace.library.uu.nl/bitstream/handle/1874/314001/54TOPHARMJ.pdf?sequence=1&isAllowed=y
http://dspace.library.uu.nl/bitstream/1874/314001/1/54TOPHARMJ.pdf

PDF, Table 1, Page 57.



> You might have been asking Alchemist but I take Trazodone too. The big thing about Trazodone for me is that it does not build any tolerance, it does not cause withdrawals, it is non-addictive etc. And it can be a very potent sleep med. Almost all other sleep meds rely on antihistamine activity for a big part of their action, this tends to build tolerance over time.
> 
> Trazodone is a sleep med that moderately agonizes 5ht1a which I basically think of as the "MDMA" receptor, because agonizing it feels the most like MDMA /ecstasy. It is strongest at antagonizing 5ht2a which is anti-anxiety, sleep-inducing, and also feels good. Moderate antagonist at 5ht2c which may help with anhedonia. It it moderately antagonizes some adrenal receptors which helps your body to calm down. Moderately antagonizes histamine receptors which acts as a sedative. At higher doses it has some SSRI action, significantly higher doses than sleep aid dosage.
> 
> It isn't in your blood stream all day so it isn't going to do TOO much during the day. For me it is a sleep med but it also feels great. No effect on appetite or nausea. The weirdest thing about Trazodone is that it significantly boosts your erections! In extreme and unusual cases it can cause an erection that lasts 4+ hours which generally requires ER visit.


sounds pretty good :yes
I will ask my psych-doc.


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## Hordak (May 5, 2017)

Gillman fan said:


> Duckbruck: Agitation and restlessness is one symptom that is "supposed" to get better as 5ht2a downregulates.


Hasn't happened yet. Not sure what to think about it. Maybe a dose increase will mitigate this side effect? I've always been a motorically very over-active person: seesawing, moving my legs, feet, toes, lips biting, fingernails biting, bruxism and so on. I am not sure what this could be? Some form of hyperactivity disorder? I've been to a few doctors, but they were rather clueless to what this could be...

-----------------------

I was very interested in Nortriptyline and my plan was to augment the Sertraline with Nortriptyline according to the article from Gillman Blog, but Lundbeck has withdrawn it from the German (European?) market as of this year :blank :no
http://www.lundbeck.com/de/service/nortrilen-truxal
Why the **** not withdraw everything from the market besides SSRIs, then it will be SSRI carousel forever and ever... :clap:sus

I've been also thinking about Mirtazapine + Bupropion, but I am uncertain if this combo is favorable to Mirtazapine + Sertraline.



Gillman fan said:


> Given this, you should try to get a Mirtazepine Rx and see how it does for your anhedonic symptoms. SSRIs tend to be more relaxing, feel good, and anxiolytic once they "kick in" over time but apathy is a side effect that usually remains. Re: the scholarly articles you linked, much of the praise regarding Mirtazepine applies equally to any med that is NOT an SSRI, e.g. most tricyclics are quite weak on serotonin. Anyway it is worth a shot. SSRI + Mirtazepine is usually better than just SSRI if you experience anhedonia. My view of Mirtazepine is overall not that great, but since most patients are forced on SSRIs, it can help to lessen the blow.


Yeahh, I guess this is the way to go. Sertraline on it's own isn't that bad. At least it is working to some extend, but augmenting it with Mirtazapine might lessen the side effects.

My appetite has come back :yes

Current side effects that are stil bothersome:
# insomnia (unrestful sleep)
# zombification
# and sometimes I have those hot flashes | heat intolerance



Gillman fan said:


> However, if you want to start afresh - I had a look at the statistics re: German prescribing and I was surprised to see tricyclics doing so well. It looks like Amitryptiline is commonly prescribed in Germany. This med is interesting for several reasons, it offers several rather unconventional mechanisms for curing depression, and it metabolizes into Nortriptyline, which is a great 5ht2a and 5ht2c antagonist, just a great med period. It is rather like having 2 medications for the price of one. I don't think it would worsen anhedonia. Moderately strong on antihistamine, it should be a sedating combo which may help with your agitation. Anticholinergic side effects may bother you, or they may not, but at least it won't make your preexisting symptoms worse.


I will keep that in mind.:smile2:
Thank you.


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## Hordak (May 5, 2017)

time for an update:

it's been 8 weeks on 50mg of Sertraline.

on the pro side:
# helps with social anxiety and somewhat with depression
# some subtle psychosomatic symptoms have diminished
# diarrhea no longer an issue! Mr. Hankey is hard and cohesive.

cons:
# insomnia | ****ed up sleep cycle
# weight loss. My appetite is nearly back to normal, but I am still loosing weight or at least not gaining any. BMI 19 right now. That is bothering me. I don't want to become underweight.
# heat intolerance (my entire life I've been loving warmth and heat. I was the guy who could sit at the top row in the sauna for 20min @ 100°C (212 °F), but right now I cannot even stand the mild summer.
# exhaustion (walking 2km around the block makes me feel exhausted & breathless. I feel somewhat weak, without power) 
# agitation /motoric restlessness seems to be worse than before taking Sertraline
# and the many times mentioned "zombification"
# mild heachache and "pressure" in my neck. Nothing bad, but very annoying in the mid and long term.

I am unsure about the further course of action: Staying on Sertraline as a standalone treatment is not an option, as the side effects are not bearable in the mid to long term. I've been thinking about the popular Sertraline + Nortriptyline combo, but Lundbeck has withdrawn Nortrilen from the German market, so this is no longer a viable option. I've been also thinking about Sertraline + Mirtazapine (heroic combo | Stephen Stahl), but I am not sure if Mirtazapine will counteract & attenuate the side effects of Sertraline!? Although it might be worth a try before discontinuing Sertraline forever...

What other options are there? Well, there are of course TCAs, which might be worth a try as standalone treatment, for example Amitriptyline, Clomipramine, Trimipramine etc.! Considering Gillmans TCA article & _"When to consider avoiding SRIs as first choice"_ I seem to be a prototype for someone who shouldn't be treated with SSRIs but rather try a TCA as first line treatment *lol*

What are your thoughts?


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## DustyShinigami (Jun 18, 2017)

Just recently been prescribed Venlafaxine after trying Sertraline and Citalopram due to how they affect my libido, but so far they're causing the same problem. I'm also combining Zyban (Wellbutrin in the USA) with them as I've read they can counteract the side affects...? I've yet to see any difference. Zyban on its own doesn't help with my depression/anxiety much, but SSRIs do at the cost of my sex drive. It's frustrating as hell. >_<


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## Hordak (May 5, 2017)

DustyShinigami said:


> Just recently been prescribed Venlafaxine after trying Sertraline and Citalopram due to how they affect my libido, but so far they're causing the same problem.


Did you try augmenting it with Mirtazapine or Trazodone?


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## neonknight77 (May 21, 2017)

It's funny, most doctor's don't have the balls to say "look kid, either you want to get out of depression and take a break with the "libido" and be a man about the problem for a few months or just keep jumping between ****". They're afraid to hurt their patient's feelings. 

I still remember the day's when libido was a natural phenomenon that took two to get it to work, nowadays it seems like it is always on call. How unfortunate.


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## watertouch (Nov 4, 2013)

neonknight77 said:


> It's funny, most doctor's don't have the balls to say "look kid, either you want to get out of depression and take a break with the "libido" and be a man about the problem for a few months or just keep jumping between ****". They're afraid to hurt their patient's feelings.
> 
> I still remember the day's when libido was a natural phenomenon that took two to get it to work, nowadays it seems like it is always on call. How unfortunate.


What is the NR.1 reason for patients to stop taking their medicine?

Libido while being depressed... Is this something that people usually have?

*Now once again you are bashing people here... *
*"take it like a man"... *Just whatta HELL kind of a comment is that.

Sexual side effects is a real problem that effects many people, this can be avoided or atleast helped with changing medicines, augments or such...

I find alot of your comments on this forum abit weird. Several of them to be just insulting.


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## neonknight77 (May 21, 2017)

watertouch said:


> What is the NR.1 reason for patients to stop taking their medicine?
> 
> Libido while being depressed... Is this something that people usually have?
> 
> ...


If you have a problem with my posts, Then be a man take care of it with me over PM. Maybe then we can reach some common ground and understand eachother a bit more equally.


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## V1bzz (Feb 20, 2017)

watertouch said:


> What is the NR.1 reason for patients to stop taking their medicine?
> 
> Libido while being depressed... Is this something that people usually have?
> 
> ...


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## V1bzz (Feb 20, 2017)

neonknight77 said:


> If you have a problem with my posts, Then be a man take care of it with me over PM. Maybe then we can reach some common ground and understand eachother a bit more equally.




I've heard what your like in PM, are you too much of a coward to do it in the open?
You keep saying sh11t like be a man, man up, man....but you sound like a little boy to me, a little boy that still hasn't learnt that it's not cool to be a bully. in the open or in PM where you seem to like to do it.


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## Hordak (May 5, 2017)

V1bzz said:


>


+2


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## watertouch (Nov 4, 2013)

Duckbruck said:


> What are your thoughts?


My personal experience of using Zoloft two times. Second time combined with TCA Clomipramine, Sert 200mg Clomi 150mg... Is that the side effects you seem to have doesnt really get that much better with time...

Question here would be if you maybe should change the Zoloft to something else.

But otherwise, something like Mirtazapine 7.5 to 15mg towards night could help against the insomnia, hunger and the heat intolerance.

About.
# exhaustion 
*(this seems weird from an SSRI*) 
# agitation /motoric restlessness seems to be worse than before taking Sertraline
*(probable caused by the increase of serotonin and how it "push" away dopamine, raising the Zoloft dose and hoping for some of that DAT action will probably NOT work*)
# and the many times mentioned "zombification"
(*this is really commen with Zoloft, actually from most SRI... But for some reason especially with Zoloft*)
# mild heachache and "pressure" in my neck. Nothing bad, but very annoying in the mid and long term.
(*i got this to specially some 2hours after taking the pills, i started to take the pills towards night when i was more "calm" it helped somewhat*)


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## Hordak (May 5, 2017)

neonknight77 said:


> It's funny, most doctor's don't have the balls to say "look kid, either you want to get out of depression and take a break with the "libido" and be a man about the problem for a few months or just keep jumping between ****". They're afraid to hurt their patient's feelings.
> 
> I still remember the day's when libido was a natural phenomenon that took two to get it to work, nowadays it seems like it is always on call. How unfortunate.


look... symptoms of major depressive disorder & dystymia include:


> inability to experience pleasure
> little pleasure in usual activities and pastimes
> reduced sex drive
> insomnia
> ...


So why the **** would I take medication that exacerbates these symptoms? :idea :um
Where is the logic in it? I want something that diminishes these symptoms!

What bull**** logic is it to say: _"You have to endure worsening of typical symptoms of major depressive disorder to combat major depressive disorder"_!?

http://i.imgur.com/iWKad22r.jpg


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## Hordak (May 5, 2017)

Laedus said:


> The only drug didn't break my dick was Mirtazapine. In fact, it can increase pleasure and libido. However, you will gain a lot of weight and it will make you quit like me and then you're back to square one.


weight gain is not a problem!
Right now I am a skinny guy, BMI 19.


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## REVIVEme (Jun 1, 2014)

I've been on mirtazapine for 5 years now for me it definitely has negative sexual side effects albeit not as severe as with SSRI but still almost no interest in women anymore and delayed orgasms. trazodone on the other hand actually boosted my sexual function quite a bit. I will try to cross taper back to tazodone this summer for that reason even tough mirtazapine is the superior antidepressant.


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## neonknight77 (May 21, 2017)

Duckbruck said:


> look... symptoms of major depressive disorder & dystymia include:
> 
> So why the **** would I take medication that exacerbates these symptoms? :idea :um
> Where is the logic in it? I want something that diminishes these symptoms!
> ...


Are you surprised when your Doctor tells you "let me get you some more pills for that"?

Because I am not.


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## Hordak (May 5, 2017)

watertouch said:


> My personal experience of using Zoloft two times. Second time combined with TCA Clomipramine, Sert 200mg Clomi 150mg... Is that the side effects you seem to have doesnt really get that much better with time...


That's a real shame.
It's my 9th week into 50mg of Zoloft, so I don't believe that it will get much better...



watertouch said:


> Question here would be if you maybe should change the Zoloft to something else.


Either that or augmenting it with Mirtazapine or something else...

You've also been taking Mianserin. How was that compared to Mirtazapine? Did you feel the NAT component?
NAT-component of Mianserin & Maprotiline seems pretty interesting...



watertouch said:


> # exhaustion
> *(this seems weird from an SSRI*)


Indeed. Maybe it's correlated with the heat intolerance & weight loss?
Or maybe the agitation and motorical restlessness is depleting me physically...



watertouch said:


> # agitation /motoric restlessness seems to be worse than before taking Sertraline
> *(probable caused by the increase of serotonin and how it "push" away dopamine, raising the Zoloft dose and hoping for some of that DAT action will probably NOT work*)


it's really bad right now. Yesterday when I went to bed, I was rolling around, curling up, "kicking" etc.! I wanted to crawl out of my skin and up the walls. I've never been that agitated & motorically restless before. I was thinking about upping the dose to 100mg to let the NAT and DAT kick in, but I also don't think that this would work. And there is always the chance that it becomes even worse.



watertouch said:


> # and the many times mentioned "zombification"
> (*this is really commen with Zoloft, actually from most SRI... But for some reason especially with Zoloft*)


is it known what mechanism is causing it?


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## Hordak (May 5, 2017)

neonknight77 said:


> Are you surprised when your Doctor tells you "let me get you some more pills for that"?


Shouldn't I be?


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## Hordak (May 5, 2017)

REVIVEme said:


> trazodone on the other hand actually boosted my sexual function quite a bit.


How was Trazodone for your depression and SA?


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## Hordak (May 5, 2017)

peoples, please vote 
Your vote is highly appreciated.

The poll is multiple choice and anonymous. Take it!


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## alchemist1 (May 8, 2017)

Hi guys, I don't want to be rude or anything, but please be aware of what you are suggesting, as some of the pieces of advice are absolute absurd. I am an aspiring psychiatrist and 

Trazodone has no effect on anxiety. It's a wonderful hypnotic so you're going to be able to sleep. But other than that, it's unfortunately not going to work for SA. 

Suggesting bupropion is simply insane. At a BMI of 19, no medical doctor is going to prescribe it. And even if undearweight were no problem, it's still not recommended for anxiety disorder. 

And weighting for like 2 months (or even longer) for the side effects to go away is a loss of time. If a side effect hasn't vanished after 2 weeks (not months!), then you need to talk to your doctor.


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## alchemist1 (May 8, 2017)

Huh, there's no edit buttonn? Wanted to correct some typos because I was using my phone...


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## SFC01 (Feb 10, 2016)

alchemist1 said:


> Trazodone has no effect on anxiety. It's a wonderful hypnotic so you're going to be able to sleep. But other than that, it's unfortunately not going to work for SA.
> 
> And weighting for like 2 months (or even longer) for the side effects to go away is a loss of time. If a side effect hasn't vanished after 2 weeks (not months!), then you need to talk to your doctor.


Trazodone might not work for SA but has showed efficacy for general anxiety - have you tried it ?

and what will a doctor do about side effects ?


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## alchemist1 (May 8, 2017)

Trazodone is nowadays primarily used for its hypnotic effects. That's certainly a good thing for people with GAD, yes. However, trazodone as a MONOtherapy is definately not a option for anything more than very mild anxiety with insomnia issues. 

What I meant was that waiting for more than 2 weeks for a certain side effect to go away (like insomnia) is simply insane. If it's not gone after 2 week, it's probably never going to disappear. A doctor can do a lot about side effects. When it comes to insomnia, adding mirtazapine or trazodone is certainly the first thing to be considered.


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## SFC01 (Feb 10, 2016)

alchemist1 said:


> Trazodone is nowadays primarily used for its hypnotic effects. That's certainly a good thing for people with GAD, yes. However, trazodone as a MONOtherapy is definately not a option for anything more than very mild anxiety with insomnia issues.
> 
> What I meant was that waiting for more than 2 weeks for a certain side effect to go away (like insomnia) is simply insane. If it's not gone after 2 week, it's probably never going to disappear. A doctor can do a lot about side effects. When it comes to insomnia, adding mirtazapine or trazodone is certainly the first thing to be considered.


I`ve taken trazodone for sleep but dont have SA, Anxiety or Depression so cant comment on its effectiveness for those but I did read its comparible to other ADs for anxiety on some of the studies on pubmed. I never really liked it though.

as an aspiring pychiatrist, what class of ADs or other meds would you favour for treating SA ? It seems like so many are hit and miss (mainly miss have to say) so do you think it has to be a combination of meds and therapy for example ?


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## alchemist1 (May 8, 2017)

Well, in order for trazodone to be an effective antidepressant/anxiolytic, high doses need to be used which are not tolerable if someone doesn't want to be heavily sedated 24 hours a day. 

I would probably try a SNRI before switching to something like a TCA or the 'atypical' medications.


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## Hordak (May 5, 2017)

UKguy said:


> Every SSRI/SNRI I have tried actually makes the symptoms worse, especially emotional blunting.





jim_morrison said:


> Yeah SSRI/SNRIs tend too because they suppress dopamine activity.





UKguy said:


> I have experienced the same on Paxil, Zoloft, Celexa and Effexor, ***** knows why these things are marketed for depression when they cause or enhance the very symptoms people are trying to get rid of. *
> 
> Sometimes they use Wellbutrin to counter the sexual side effects. You could try a Tricyclic but they have their own issues like dry mouth, weight gain, constipation and so on.


That's what I've been asking myself for the last few weeks.

As I understand it, pure SRIs are dampening the noradrenergic and dopaminergic transmission, thus causing the zombification-symptoms in a subset of patients. Is that correct? So what would be the theoretically ideal solution to this problem? An NDRI as augmentation? Or an SSNDRI with some H1-binding as standalone drug? Does something like this even exist?

something like the following would be interesting:


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## jeanny (Apr 17, 2014)

Drugs and porn will destroy you.

Say no to SSRIs, though.


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## Hordak (May 5, 2017)

jeanny said:


> Say no to SSRIs, though.


Keine Macht den SSRIs ^^


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## jeanny (Apr 17, 2014)

Duckbruck said:


> Keine Macht den SSRIs ^^


My shrink took me off Sertraline, in just a week. I thought it would take longer.

Those side effects I told you about are gone (I'm still fat and blind, tho). Now I will need another favor...feel free to say no :um


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## Hordak (May 5, 2017)

jeanny said:


> Those side effects I told you about are gone (I'm still fat and blind, tho)


Did you try Bupropion?


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## jeanny (Apr 17, 2014)

Duckbruck said:


> Did you try Bupropion?


Nope.


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## Canadian Brotha (Jan 23, 2009)

I can't speak to all those classifications but the only antidepressant I ever tried that didn't cause anorgasmia was Wellbutrin


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## Hordak (May 5, 2017)

Canadian Brotha said:


> I can't speak to all those classifications but the only antidepressant I ever tried that didn't cause anorgasmia was Wellbutrin


thanks for your post.
Every input is appreciated.


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## Hordak (May 5, 2017)

Voters: 10

Good, but I want my 100 votes :b
Keep going, peoples... :yes


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## DustyShinigami (Jun 18, 2017)

While it's true that bupropion causes the least sexual side effects (and I'm taking it too), I don't feel as though dopamine on its own helps with my depression. I need serotonin primarily.


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## watertouch (Nov 4, 2013)

alchemist1 said:


> What I meant was that waiting for more than 2 weeks for a certain side effect to go away (like insomnia) is simply insane. If it's not gone after 2 week, it's probably never going to disappear. A doctor can do a lot about side effects. When it comes to insomnia, adding mirtazapine or trazodone is certainly the first thing to be considered.


What are your thoughts about the initial side effects of SSRIs or the delay of the therapeutic onset of SSRI?



> I am an aspiring psychiatrist


:afr

What are your thoughts about Trazodone and penile function?


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## watertouch (Nov 4, 2013)

Laedus said:


> I will add that if you go on Mirtazapine you need to quit alcohol. It is a very very bad combination. If you're not prepared to quit alcohol don't bother.


Never heard of this before! why would that be a "very very bad combination"???


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## Hordak (May 5, 2017)

DustyShinigami said:


> While it's true that bupropion causes the least sexual side effects (and I'm taking it too), I don't feel as though dopamine on its own helps with my depression. I need serotonin primarily.


and what about Norepinephrine?


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## ImperfectCircle (Jun 1, 2017)

I didn't see it in the list, but 5-HTP seems to be working for me. I think it might actually be enhancing my sex drive some.


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## Hordak (May 5, 2017)

ImperfectCircle said:


> I didn't see it in the list, but 5-HTP seems to be working for me. I think it might actually be enhancing my sex drive some.


[x] Others | e.g.: Agomelatine, Ketamine, Tryptophan, St. John's Wort, Lithium, T3/T4 etc.


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## DustyShinigami (Jun 18, 2017)

Duckbruck said:


> ans what about Norepinephrine?


Possibly that too. My venlafaxine supplies that.


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## Hordak (May 5, 2017)

Need more votes :=)


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## Hordak (May 5, 2017)

I have QTc prolongation with Sertraline... :|


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## tomverlaine (Jul 27, 2017)

FWIW, the only antidepressant that boosted my depression induced low libido was Saint John's Wort. it's predominantly dopaminergic. on the other hand in combination with SSRIs it allegedly could lead to serotonin-syndrome, which i guess means that it does have serotonergic action as well. (which is a pity, would love to combine it with an SSRI)


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## Hordak (May 5, 2017)

It's becoming more and more frustrating do deal with those doctors. For the last few months I visited 3 doctors and all of them wanted to put me on the SSRI carousel, although I explained to them that I don't react well to SSRIs. I suggested Mirtazapine to everyone of them and that for obvious reasons _(underweight, bad sleep, apathy, anhedonia...)_, but the answer was always the same: _"We will discuss this another time. Until then I want you to take your SSRIs!"_

What angers me the most are their reactions to my side effects: _"Well, if you want to get better, you have to stick with it! Side effects are a necessary evil!"_. I wonder how side effects, which are comparable to my depressive symptoms, will help or cure me?

I don't know what to do...


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## sming (Apr 12, 2010)

I suggest a new poll:

who thinks

"View Poll Results: Which antidepressant class is least prone to cause zombification & sexual problems?"

should have been

"View Poll Results: Which antidepressant class is *MOST *prone to cause zombification & sexual problems?"

Apolgies - I for one voted the "wrong" way. Strike one off of SSRI's and SNRI's.


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## Hordak (May 5, 2017)

sming said:


> I suggest a new poll:
> 
> who thinks
> 
> ...


I am sure an Admin will correct this for you ^^


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## Memories of Silence (May 15, 2015)

sming said:


> I suggest a new poll:
> 
> who thinks
> 
> ...


I have fixed it for you.


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## sming (Apr 12, 2010)

Silent Memory said:


> I have fixed it for you.


Much obliged!


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## Hordak (May 5, 2017)

Now the entire Poll Results are useless! :crying:
@admin. Please reset the Poll. Thank you!


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## Lohikaarme (Aug 28, 2013)

Hordak said:


> Now the entire Poll Results are useless! :crying:
> 
> @admin. Please reset the Poll. Thank you!


Poll reset.


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## Hordak (May 5, 2017)

Lohikaarme said:


> Poll reset.


thanks 
Is it also possible to reset the number of Votes? (_ Voters: 20. You have already voted on this poll_, although there is only one vote :b )

I would like to vote :yes


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## Lohikaarme (Aug 28, 2013)

Hordak said:


> thanks
> Is it also possible to reset the number of Votes? (_ Voters: 20. You have already voted on this poll_, although there is only one vote :b )
> 
> I would like to vote :yes


I'm not seeing the option to reset the number of voters anywhere. Presumably, an administrator would have full access to poll editing.


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## Hordak (May 5, 2017)

Lohikaarme said:


> I'm not seeing the option to reset the number of voters anywhere. Presumably, an administrator would have full access to poll editing.


:grin2:


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## SplendidBob (May 28, 2014)

Apathy is the reason I cancelled my psych appointment yesterday for later in the month. I mean, apathy from meds. It's currently my biggest problem, and its possibly related to low blood pressure, so even meds like MAOI's are something that probably won't help me. 

I just feel a kind of constant mental fatigue currently, though this may be due in large part to problems sleeping, stress, poor diet, caloric deficit, overtraining, **** like that lol. I am probably going to have to try those weird stockings you place over your legs to improve circulation to the brain if this continues though.

SSRI's though, yeh, **** those for apathy.


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## Hordak (May 5, 2017)

splendidbob said:


> SSRI's though, yeh, **** those for apathy.


Indeed!

*@Moderator / Administrator:* Could you please delete the Poll. I will make a new one!


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## Hordak (May 5, 2017)

SplendidBob said:


> Apathy is the reason I cancelled my psych appointment yesterday for later in the month. I mean, apathy from meds.


My thoughts exactly...


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