17 replies to this topic

[▲420MD]

So, I'm going to the doctor tomorrow I've been all over the place in terms of western medicine. I want to try some new stuff and I'm sure I'll get some good ideas from the folk here.

I need some sort of "Anti-Depressant" that will help with anxiety, motivation, and keep restlessness down without being a sedative.
I can basically get any medication, it just needs to be active in the US Market.

What I used to have going was Mirtazapine 90mg + Tramadol 300mg + 60mg Baclofen + 0.5 Pramipexole but I cut out the Tramadol and Pramipexole.
I've been completely off the Tramadol for like a week now, and have been using low dose naltrexone with great benefit in that section.
I've lowered my dose of Mirtazapine from 90mg to 75mg but I'll be able to get a replacement whilst still being able to taper myself down.

Still though, I need something to "pep me up" like the Tramadol would normally do - something to get me up and moving with precision. Tramadol was an opiate, but it was like a study drug to me... I could take it and damn I blew through school so fast it WAS funny lol. I don't like the idea of Opiates inhibiting neurogenesis and I'm already on a steady dose of LDN I'd rather not kill. I know Effexor is like Tramadol but the withdrawal effects of Effexor are what made me choose the Tramadol in the first place.

My anxiety, is performance anxiety I believe it's dopamine related since its completely abolished it D2/D3 agonists like pramipexole. I just don't know about the long term safety of drugs like PPX...
By performance anxiety, I mean how well I can do a task - I don't think I have low dopamine since my sexual capability is just fine, but I think I do have some kind of partial hypo-function of at least some dopamine receptors.

[xks201]

I'd focus on balancing hormones.

[Tom_]

Tramadol is very much related to venlafaxine. Californian rocket fuel (mirtazapine and venlafaxine) is a very effective antidepressant combo. However, you said you wanted something more stimulating. Milnacipram is on the market in america but is only approved for Fibromyalgia, although it is used off licence often as an AD and is approved in many other countries. Milnacipran is a much more potent inhibitor of noradrenaline reuptake than venlafaxine. Levomilnacipran has just been approved in the US for depression although I'm unsure if its as potent an SNRI as Milnacipram - its likely to be at least close. I don't know if Viloxazine has been approved in america but it is also another option. You may like to consider Bupropion alongside Mirtazapine. Another option is aripiprazole an atypical antipsychotic which is not often sedating and very effective as an adjunct (another option is ami/sulpride which is paticaully effective, quite stimulating but fairly side effect heavy). Noratyptaline is a great option. One of your best options is T3, its one of the most potent agumentaive agents and although its not used all that often anymore all psychiatrists should be willing to prescribe it. It will increase monoamine transmission and will improve energy.

Edited by Tom_, 13 October 2013 - 09:03 PM.

[▲420MD]

I'd focus on balancing hormones.

Yeah, we aren't at the point - in the US at least, where we can get neuromodulators or neurohormones prescribed outside of ER's...
My T is High, and all my other hormones are in range, at the higher end of the spectrum for an 18-25yr old.

Edited by ▲420MD, 13 October 2013 - 10:53 PM.

[▲420MD]

I'm looking at the Milnacipram, still if anyone could bump with more information I'd appreciate it.

[▲420MD]

Bump

[Tom_]

'Balancing hormones' isn't going to do you any good unless you have endocrine pathology (sub-clinical still counts but it has to be severe enough an endocrinologist or G.P would still treat) because otherwise it isn't causing your problems. This comes with a few exceptions - T3 can be a useful adjunct in euthyroid patients and estrogen is a possible adjunct in certain women. However this should be carefully monitiored to ensure endocrine disorders aren't caused.

Cortisol inhibitors (antagonists are being studied at the moment) may be useful in carefully selected patients with severely depressed patients with psychotic, melacholic or catatonic symptoms.

By high T what do you mean? What in paticular is high? T3? T4? Is it actually high or within range? Have you got numbers? Hyperthyroidism is typically associated with mania and psychosis not depression.

There isn't much more information on Milnacipran that I can think of as relevent? What else would you like to know?

[3AlarmLampscooter]

Newmind sells tianeptine.

[▲420MD]

'Balancing hormones' isn't going to do you any good unless you have endocrine pathology (sub-clinical still counts but it has to be severe enough an endocrinologist or G.P would still treat) because otherwise it isn't causing your problems. This comes with a few exceptions - T3 can be a useful adjunct in euthyroid patients and estrogen is a possible adjunct in certain women. However this should be carefully monitiored to ensure endocrine disorders aren't caused.

Cortisol inhibitors (antagonists are being studied at the moment) may be useful in carefully selected patients with severely depressed patients with psychotic, melacholic or catatonic symptoms.

By high T what do you mean? What in paticular is high? T3? T4? Is it actually high or within range? Have you got numbers? Hyperthyroidism is typically associated with mania and psychosis not depression.

There isn't much more information on Milnacipran that I can think of as relevent? What else would you like to know?

By high T I meant high testosterone.

But can anyone reccomend antidepressants/antianxiety medications that are helpful with motivation, but calmative also. Something "nootropic-like" thats not a stimulant.
I'm down for combinations. I have no copay and my doctor is open.

If I did say, Keep a low dose of 15-30mg of Mirtazapine would the 0.5mg of Pramipexole stil affect me in the long term? The side effects are permanent I've heard.

[Tom_]

Long term dopaminergic agents aren't the best way to handle anxiety, if it becomes the only thing that works then go for it.

Any noradernergic agent will increase dopamine activity so these are options.

You could try Bupropion and another option is Aripriprazole a D2 partial agonist.

Buspirone is almost always decidedly unstimulating but is very effective for anxiety, its a D2 & D3 agonist.

[nupi]

Bupropion is likely a bad idea if anxiety is an issue.

Closest options to Tramadol would probably be Duloxetine and Venlafaxine- both have their place but they would not be my first pick. For the regular stuff. Fluoxetine is the most activating but it may still lower motivation.

From personal experience, it is almost impossible to get TRT unless your T levels are really far down.

Edited by nupi, 14 October 2013 - 12:55 PM.

[Tom_]

Typically I'd agree nupi but the OP said a dopaminergic agent (Pramipexole) helped his anxiety. It MAY suggest the presence of ADHD.

Low dose Amisulpride or sulpride are high side effect options but incredibly effective antidepressants in low doses (lower doses of course mean the awful side effect profile is much more mild - maybe less than a first or second gen TCA) (selective to D2 autoreceptors (increases dopaminergic release from D2/3 neurons)). They aren't approved in the US but I've heard of people being prescribed it in the US - so its a possibility.

Otherwise Protriptyline or Noratyptaline are very good options. Now I've named as much as I can think of really :L

[88LS]

Escitalopram.

[jadamgo]

Bupropion gets a bad rap for increasing anxiety, but over the long term it usually decreases it both in healthy controls and in the anxiety-disordered. You just have to put up with a few weeks of feeling worse before you feel better -- but then again if you start an SSRI first and then add bupropion later there's usually no problem at all.

Did you have a specific question about milnacipran I could answer? I don't understand what you want to know about it.

[nupi]

Actually, in my case the anxiogenicity crept up on me after like half a year of taking it. If you search through this forum, I loved the first couple of months (something like May to August 2011) on it (it was kind of like a super caffeine to me), then progressively got to hate it more and more as the beneficial effects faded and the side effects got stronger and stronger.

As for Tom's argument, Bupropion is at best a weak dopaminergic, if he really wants to try and treat ADHD, I would start with MPH [1] or perhaps D-AMP.

[1] Though I will admit that I have a small obsession because of not being allowed to test drive it

Edited by nupi, 14 October 2013 - 07:22 PM.

[Tom_]

The OP is already on MPH

[▲420MD]

The OP is already on MPH

Not taking MPH, not sure where you got that from...

I'm stuck with 60mg Mirtazapine , up to 300mg Tramadol, 0.5mg Pramipexole and 80mg Baclofen. I think that'll keep me fine. Not sure how "good" it is,I would have rather tried new medicine than the ones I've been using.

[nupi]

That's a pretty strong cocktail, I am surprised they would prescribe all that...