67 replies to this topic

[Tom_]

If you haven't built almost total tolerance within 3 days I'd be surprised. None the less it will happen.

Diphenhydramine isn't the safest, not by a long way. Its a potent anticholinergic alongside being an antihistamine - which you have already been using in the form of Imipramine. The two of those profiles are certainly not the best or the safest way to get to sleep. I wouldn't reject that by itself as a way to get to sleep if you actually can't but combined with the fact that its about to top working and that makes them useless.

You are much better off with Trazadone, Mirtazapine or the like.

[Atropy]

I agree with the Diphenhydramine not being safe.

My doc prescribed Trazadone 25mg and Alprazolam 0.5mg to take together.Should I take these together?Or should I maby try one at a time as my receptors are sensitive,so It will take a longer time to build up tolerance.I intent to cycle these and try the benzos last.To be honest I don't want to use the benzos,I dont feel its necessary right now unless the trazodone does not work.

Can you guys work out a cycle program for me,maby 3 days trazodone, then 3 days tryptophan,melatonin Valerian,skullcap,californian poppy etc?

Also what dosage should I take the Trazodone?
Also,I am not too sure if I received the correct thing.

The trazodone does not conform to the pictures of it on the net.THe weight of the pill is 150mg,the dosage is apparently 25mg.Its a blue pill,round.

The alprozolam is 130mg,the dosage is 0.5mg.THis one conforms to the shape of Alprozolam.

[nowayout]

Diphenhydramine isn't the safest, not by a long way.

You are much better off with Trazadone, Mirtazapine or the like.

Hmm, I don't think so. Have you looked at the incidence of side effects of mirtazapine? Very common incidence of weight gain, dry mouth, constipation. Common incidence of weakness, thought disturbance, increase in serum triglycerides > 500 mg/dL, peripheral edema, etc. I think diphenhydramine is OTC an mirtazapine isn't OTC for good reason.

[Tom_]

Weigh gain in adults is actually reasonably rare, around 7% and increase in cholesterol is limited to those who suffer weight gain. Weakness, thought disturbance and the like are caused by its sedating effect and one would expect them to be at least no more common that DPH - which according to side effect profiles resembles that. Dry mouth, constipation and the like you will find no argument from me. However DPH can cause urinary retention, dry mouth etc and in that regard side effect profile they are roughly as bad or as good (depending on perspective) as each other imo. However toxicity and abuse potential and the like are much worse in DPH. But the most important thing is while Mirtazapines effectiveness as a sedative might wear off DPHs effects are likely to last only a few days before requiring a month or longer before being of use again. Mirtazapine typically is still working at one month. Of course the option of Trazadone is even less invasive than Mirtazapine. And Mirtazapine/Trazadone also have AD effects.

To the OP, Tryptophan absolutely should not be taken with any MAOI unless part of a very careful management plan. At doses of 3Gs its at least as dangerous as taking a real SSRI. The risk of a reaction is pretty small but I certainly wouldn't risk it.

Trazodone at 25mg is a very low dose. I don't like prescriptions of alprozolam but its hardly a big problem. Together I expect they will induce sedation and with some sleep hygiene I imagine sleep won't be an issue. I suspect although may prove to be very wrong, one alone won't do the job. Do try the Trazodone alone first if you would like but I cannot impress upon you enough the importance of sticking to what you have been prescribed unless in an acute emergency (otherwise there is no way to tell what is having an effect) - as in if I don't take this then I will attempt to seriously harm myself. The trazadone dosage shouldn't exceed 150mg until treatment resistance to moclobremide has been established and even then there are better options. I understand the desire not to take Benzo's but I suspect what ever is causing this inability to sleep (more severe than usual) will pass reasonably quickly and feel its better for you to get a good nights sleep now rather than get even more exhausted. Try a week of them and see what happens.

I expect you have the right pills - what with various people selling them, they often look different sometimes even when from the same company.

[Atropy]

Aah fuck.I was taking shit loads of Trytophan.No wonder it didnt work.You didnt leave a name for the Benzos,and I didnt ask for them,But afterwards I read that this one has shittier sides than others.

Yeah,I told the doc Traz or Mirtar.He wanted something that hit different parts of sleep,something for induction and for longer sleep etc.

Im thinking of doubling up the Trazadone and ignoring the benzos.I dunno,Ill experiment.
Does Trazodone have long term therapeutic effects?Is it bad to cycle it in general?


Ciltep and moclobemide works so well for social anxiety,for me.THere is however a slight hint of agression/irritable,a very slight bit,or maby thats confidence or increased focus.But I will cease that up until after 6 weeks to see how the Moclobemide works,as you suggested.

Also the doc said tis ok to take moclobemide at night and mornin,or just morning but that its up to me,
Cheers.

Edited by Atropy, 15 November 2013 - 04:26 PM.

[Tom_]

I think he made a good choice using low dose combinations, in this case. As it is, the Benzo itself may help reduce the depressive symptoms.

Experiment is exactly what I wouldn't do. Trial the scripts as given to you and IF that works then if you feel it necessary and preferably with your doctor aware experiment. Both Trazadone and Benzos can help with depression, the Trazadone isn't likely to do much at that dose and cycling it would be equivalent to cycling Moclobremide (in regards to AD effect, its effect on sleep will be the same). Benzo's may be effective at that dose for depressive symptoms although because you do fit on the Bi-polar spectrum the effectiveness of both Trazadone and Benzo's are less likely to cause that.

If you have been taking a lot of Tryptophan that could have been the cause of the insomnia - certainly may not have helped, on the other hand it could still act to sedate (something I expect is less likely) and in reality it was likely not doing much of anything.

I know its tempting to play around with meds constantly to find what works best and by god I've done it - it never did me any good and it won't do you any either. I swap my sleeping meds very often - simply due to lack of any other option and I don't like doing that. I'm almost always on here cruising for other options but I don't start them until I'm 8-12 weeks into monotherapy. If you look at the cases presented by Stahl (one of the leading psychopharmacologists) he often increases and adds/subtracts meds even more slowly in very ill patients.

[deeptrance]

Trazodone is a lot more potently serotonergic than tryptophan (a mere precursor) and thus I would think it would be the one to avoid while taking Moclobemide, although with Moc being reversible the risk of hyperserotonemia is reduced. If tryptophan were a real risk then there would be warnings about using it with MAOIs along with the warnings about tyramine.

My closest encounter with death occurred as a result of following a psychiatrist's orders by taking citalopram (an SSRI) for depression and trazodone at night for sleep. After I was discharged from a 4 day stay in hospital I asked my pharmacist about that combination and he said they should never be prescribed together. My serotonin receptors are hypersensitive yet I've never had any issues with tryptophan alone or in combination with serotonergic meds.

Edited by deeptrance, 15 November 2013 - 10:10 PM.

[Tom_]

There is no such thing as a mere precurser, they are just as potent - in particular in dosages like that, the only difference is there effects are much shorter lived. L-Tryptophan combined with a TCA can increase response rates massively.

Trazadone below 150mg is mostly not serotonergic. Its SERT affinity is so mild verses its Serotonergic antagonist profile that it is effectively only a serotonergic antagonist. Above 150mg and it starts to also have clinically relevant SERT inhibition.

There should be a warning about using, DLPA, L-Tryptophan, L-Tryosine or L-Dopa with Moc, however they just put it under the warning of "if you are on any supplements, tell your doctor".

I'll be frank, I struggle to believe Citalopram and Trazodone unless taken in overdose would cause a Serotonergic toxidrome. One requiring a 4 day hospitalization would require seriously abnormal ECG (TDP or the like) with hypotension or severe hyperthemia. As a side note, 6-9.6 grams of trazodone typically can be discharged after 24hours with some IV Benzo's, fluids and a psych consult.

[Atropy]

Deeptrance I sure as heck hope that doesnt happen to me and sorry to hear that happened to you.I really need to do more research on the stuff I put into my mouth.

To be honest tryptophan and b6 did work work well with imipramine.Deeper sleep,easier to fall asleep.

"There should be a warning about using, DLPA, L-Tryptophan, L-Tryosine or L-Dopa with Moclobemide"
Any other things should I avoid ?i don't wanna screw things up.L theanine ,valerian,california poppy,skullcap,piracetam,noopept,ginko,ginseng.

Offcourse I only plan to take these things after 4 weeks or after the xanax is dropped.

My mood and socialness is amazing on this combo of moclobemide,xanax and trazodone.Never been this social,and its not Mania.Anxiety is almost non existent.

However I think mental performance may have suffered slightly,im abit dull now.I am definitely more in tune with social situations tho and I am an all round great person at the moment.I am perfectly appropriate in social situations and really comfortable in my mind which is something I am not used to. Obviously this slight boost is due to the trazodone and xanax combo.But the bulk of this change is Moclobemide.

How long should I stay on this benzo and trazodone combo according to studies,your opinion etc.?I am hoping to drop the benzo at some point but keep the Trazodone as you had prescribed,then eventually boost up the dosage of the Moclobemide and then I can really get things going.

And if all goes well this stuff will not stop working.

Cheers

Edited by Atropy, 17 November 2013 - 01:35 PM.

[Tom_]

Standard Benzo time is 4-6 weeks. Other than a shit load of tolerance I've been using Benzo's of various descriptions for the best part of 2 years without addiction setting in. The slight decline in cognitive functioning is likely mostly due to the Benzo. That has a good chance of failing off within a few days or weeks but may persist. Trazadone may have some part to play in it but again its something your body should become used to. I'm glad to hear about the improvement.

[Atropy]

Thanks allot Tom.Guess I will finish this course and see what happens.

[Tom_]

About my last post. I'm not saying I don't believe you (in regards to the serotonin toxidrome or at least being very ill). I'm saying its very unusual and there could be more than meets the eye - maybe an atypical allergic reaction or the like. I however seriously doubt it was serotonin causing the problem. I just realized I didn't make that clear.

Atrophy:
If you continue having success with the combination I suggest you stick with it. If and when you withdraw the Benzo upping the Trazodone (below 150mg) is certainly a possibility. Other drugs you might consider if you still find yourself not fully better (and without psychotherapy and behavioral changes I suspect you will not find yourself fully better).

Atypical antipsychotics: They are known for having horrendous side effects but used at doses for MDD most of these side effects are mild and quite tolerable. Chosen correctly they can also be potent sedatives. Using short release formulas the sedative effects during the day are less likely to be of bother. Weight gain is reasonably likely (depending on what you choose) but to some extent Moclobremide will act against that. They may even more useful in your case because you fit onto the Bi-polar spectrum. A low dose of quetiapine (25mg) increasing to a maximum of 300mg would be where I recommend starting. Amisulpride, aripiprazole and Olanzepine are also good options.

Triiodothyronine is well researched as an adjunct to TCA's but there is some good evidence for there use in SS/NRI's. Due to the lack of combination evidence for MAOI's in general its hard to tell whether it would be useful but I suspect it may be. There is some evidence it may be useful for Bi-polar disorder type 1 so may be extraboable to spectrum disorders although t4 seems to preform better for Bi-polar.

Trimipramine the most sedating antidepressant, it doesn't have re-uptake affinity and will work much like imipramine in helping you sleep. It seems safe to combine with MAOIs and also acts as a D2 antagonist. This means it might have some extra efficacy due to your Bi-polar spectrum. Side effects are much like Imipraine and not 'great'.

Mirtazapine - already mentioned but if Trazadone turns out to be a dark alley then I'd skip this.

Antiepileptics might be useful. Valporate is the standard first trial. Carbenzapine might also be worth a shot. Both have shown to improve depressive symptoms but mostly work to improve psycho-social functioning. I suggest them for much the same reason - bi-polar spectrum. They also work on GABA which you seem to have had a very positive response to but without the risk of addiction.

Lithium is the gold standard. I'd hold it back in reserve but if need be this is the secret weapon.

Agomelatine is an AD which shows good efficacy. It theoretically should improve sleep but with you being on an MAOI it might not do so. Its a very low side effect drug so could be of interest.

All of these options shouldn't be trialed until Trazodone has been given a fair trial, that is 6-8 weeks. I've written them so you can have a look and decide if you think you might want to give any a go.

What dose of Moc are you on? If you are on 150-300 you should wait the four weeks you have left and then increase to 450 for two weeks and finally 600 for 2-4 weeks before you decide to make any other changes (other than scrap/increase dose/swap the Benzo - if you want) and then play about with the Trazodone or increase the dose of Moc. After that you could consider one of the above or something else. If you are already on 600mg I'd turn those 4 weeks to 6 but its not necessary but MUCH preferable. If you are on 450 wait 2 weeks and increase the dose to 600mg.

[deeptrance]

I'll be frank, I struggle to believe Citalopram and Trazodone unless taken in overdose would cause a Serotonergic toxidrome. One requiring a 4 day hospitalization would require seriously abnormal ECG (TDP or the like) with hypotension or severe hyperthemia.

This is interesting and I'd like to explore your thoughts further. First, I should clarify that the hospitalization for 4 days was due to a concussion that knocked me unconscious, which I sustained upon having a grand mal seizure that caused me to stiffen up "like a board" according to a witness and then I fell backwards and slammed my head on the corner of a coffee table. So... at least you're right about that much, even if I did have SS it was not the reason I was hospitalized for days.

I don't want to derail this thread by getting into my story so maybe I should message you privately, or if the OP doesn't mind then I'll share the story here. Either way is fine with me.

In support of your comments re: tryptophan, I found this:
^ Oates JA, Sjoerdsma A (December 1960). "Neurologic effects of tryptophan in patients receiving a monoamine oxidase inhibitor". Neurology 10 (12): 1076–8. doi:10.1212/WNL.10.12.1076.PMID 13730138.

Edited by deeptrance, 18 November 2013 - 02:26 AM.

[Atropy]

I don't mind you posting here Deeptrance,go ahead.Also,does one need a membership to view that study you posted because I cannot view it?

[Tom_]

I'd love to hear the story as well. If you don't mind talking about it. It seems to be very unusual. I mean a serotonin toxidrome isn't out of the question - people do get mild to moderate reactions on a normal dose of ADs without any REPORTED combinations (they may have been using drugs of abuse, supplements or OD'd and don't want to admit it) but its very rare.

[BlueCloud]

But the most important thing is while Mirtazapines effectiveness as a sedative might wear off DPHs effects are likely to last only a few days before requiring a month or longer before being of use again. Mirtazapine typically is still working at one month.

Diphenhydramine isn't the safest, not by a long way.

I'm sorry but that's absolute bullshit. I've taken diphenhydramine ( and doxylamine, and cyproheptadine ) on and off for a decade. Dph multiple times a week, it absolutely didn't require "a month or longer to be used again". In cases were it started loosing a bit of potency, a couple of days were enough to make it work again. Not that I recommend taking them chronically at all, but they were the only thing that provided me with restful sleep with my severe insomnia.
But saying that mirtazapine is a safer option is nonsense. Mirtaz sedative effects linger on for much much longer than dph or doxy, almost 24 hours of being zombified, unlike the others , wich effects dissipate after 8 or 9 hours ( especially dph wich is more short acting). I suffered through mirtazapine chronically for a month ( with terrible results), and it's long list of side-effects took weeks to dissipate after I stopped it. You can't even begin to compare mirtazapine and dph ( or doxy) when it comes to side effects....

There is a reason I don't suggest adaptogens. There efficacy is not shown and far from guarantied, they carry more risk than Benzo's simply because nobody knows how they work. Tolerance can be a major factor in there use as well. Long-term use of Z-drugs (I let them fall under Benzo's) is typically safe and while withdrawal symptoms might be present often dose escalation beyond prescription guidelines aren't needed - I would be a bad example of that, I can take 15mg of zopiclone to little effect.

It is absolutely crazy to suggest that benzos are "safer" than adaptogens, "because nobody knows how they work", even pharma representants wouldn't dare such thing nowadays. There are a ton shit of studies on various so-called adaptogens ( bacopa, ginseng, ashwagandha, etc..), and while I would NEVER claim that a natural supplement is by definition safer than a pharmaceutical, many of those herbs are an order of magnitude safer than some benzos and some SSRI crap. And we have the advantage of MILLIONS of users over CENTURIES ( if not thousands of years) , if one of those herbs were more dangerous than some pharmaceutical, entire populations and countries would be decimated by now.

[deeptrance]

My serotonin syndrome (allegedly) story:
4 years ago I was put on citalopram by a psychiatrist who was unimpressed by my statement that all previous trials of SSRIs gave me horrid side effects at the normal starting dose, and these sides always commenced within about 2 hours of the first dose. I know, that's unusual, but it's very real. My life-long best friend is a psychiatrist who thinks this type of reaction is more common among those of us who have an extensive history of using psychedelics, as he has seen a pattern of this in his own patients and in his personal experience. Apparently a few trips can permanently change certain receptor sensitivities or whatever...

So I started on the citalopram at half the normal adult starting dosage (per my request) and within a couple days I was having trouble walking. I felt like I was on a boat that was slowly rocking, and I kept losing my balance. I would have to hold onto something just to walk. I told the shrink about this and he said that it was normal and that it meant it was going to work. He told me to increase to the regular adult starting dose, so I did. Then I couldn't sleep whatsoever, so he prescribed trazodone. Beginning around day 5 of citalopram and day 2 of trazodone, I became semi-incoherent, unable to carry on ordinary conversation, unable to sleep, with a hallucinogenic quality to my perception of reality. Of course I was unable to drive as I was also unable to do most everything else. Fortunately I was staying with friends who took care of me for the next few days, which were totally bizarre.

My brain became totally attuned to certain types of information processing. I could read Discover magazine from cover to cover and understand the whole thing, but I wasn't able to focus on a single sentence of ordinary human discourse. Couldn't comprehend anything about emotions, philosophy, social information. I was very lucid but I couldn't communicate with the outside world. I stopped taking the trazodone after the 3rd night and kept getting worse, so I stopped the citalopram but it was too late.

The morning after I went off the citalopram, I went into violent thrashing of my limbs and hyperreflexia. My friend called 911, and after I was taken into the emergency room I began yelling uncontrollably. It was nonsense, I couldn't control what my voice was doing. My blood pressure measured around 220 over 130. I was totally lucid and I aware of everything that was going on. I managed to barely utter "serotonin syndrome" to the doctor, who immediately dismissed that as a possibility, and then they proceeded to try a few things on me. First, benadryl, in case I was having an allergic reaction to something. I don't know what they did next but nothing change. For the next couple hours I kept uncontrollably thrashing my legs and arms, hitting myself on the head, and banging my head on the pillow, and I was loud as hell. I thought this was what hell must be like because I was so totally aware of everything and couldn't control anything and couldn't connect to anyone.

Eventually a nurse came in and gave me a shot of ativan and within 1 minute I sat up, perfectly normal and feeling fantastic, and I said, "I KNEW a benzo would work!" because my psychiatrist friend had told me that benzos have a particular type of efficacy in treating some aspects of SS. But it was a stupid thing to say because now the doctor decided I was just a drug addict seeking benzos, and I've never had a benzo addiction and hadn't taken anything like that in recent weeks. They discharged me with instructions from the original prescribing psychiatrist to "keep taking the citalopram and trazodone", to which I responded, "He's a maniac!"

I did OK for the rest of that day but the next morning was a disaster. My friend who was taking care of me took me out to do some errands and tried to get me to be normal and fight my way through it. Things kept getting weirder. She had to help me walk everywhere and I couldn't make sense of things. After we got back to her house I lost all memory so this is what she told me. She said we were talking and I was standing up and I started babbling incoherently, then I let out a blood-curdling scream that she said was the freakiest sound she has ever heard come from a human, I foamed at the mouth, stiffened like a board, and fell backwards. The back of my head hit the sharp corner of a heavy wood coffee table and she said she thought I died because I was then unresponsive, bleeding profusely, and continued foaming at the mouth.

My memory is foggy about my time in the hospital, I only have a vague image of lying in a bed and I was there for a total of 4 days/3 nights. There was never a diagnosis and I wasn't given a shred of information about what happened when I was discharged. I need to go back and get my records to see if they came up with anything.

Atropy: I found the reference regarding tryptophan on the Wiki page about serotonin syndrome. Apparently SS was first observed in patients who were taking trypt. with serotonergic meds.

[Tom_]

It does have parallels with serotonin syndrome but it doesn't 'fit the bill'. I think it's an unlikely diagnosis although allergic reaction is also clearly not the cause. Delirium would have been one of the first presenting symptoms if it was Serotonin and I assume you were taking Trazadone below 150mg - in which case it would reduce the effects of Serotonin (working as an antagonist). I'm not sure what it is and it could have been SS but I doubt it.

[Atropy]

I have been on Moclobemide for 2 weeks now.

I have probably been on the trazodone and xanax for around 8 days.

Over the last week I think the effect of the medication/s have declined at the same speed that it had started working in the beginning.Maby I am not being objective.

Slowly my short term memory has been getting worse.The anti-anxiety and anti-depressive effects have halved now as compared to a week ago.Also thtere is a slight irritablilty that I have now.

Im getting worse in social situations.Its very discouraging.Moclobemide still has an effect but not as great as before.

It has been a stressful week tho,but I dont think it was that.It may have been stressful because the meds have become less effective?

I take 150mg when I wake up and 150mg after lunch.My last day had social situations in the evening and I wasnt able to function in a normal way in that situation.

I think I may be feeling that effect that many users report when not ingesting the drug frequently throughout the day but that does not account as to why my mood has lowered during the day,because I dont take it at night.

I knew that this drug had a possibility of not working,is it too soon to tell if its no good?I know its only been 2weeks.

Also,maby its because my mind is more active at the moment,but I think that I may be gaining tolerance to the benzo/trazodone combo ,because I was not able to sleep late at all when I wanted to,but maby thats because its so hard to wake up from sleeping that I conditioned myself to wake up that early.

What do you think?

[nowayout]

It is probably the Xanax causing these bad side effects.

[Tom_]

Its way to early to tell. Way to early. Tolereance is extremely unlikely. Practice sleep hygeine alongside it. The most common reason people fail sleep aids early is they 'fight' them or arent doing normal bed time things.

[dunbar]

I have a question for Atropy,

In opening post you named all the meds and supplements you were taking back then. Imipramine + tryptophane and many herbs and so on.
How did you know if that's even safe and possible? Especially when it comes to herbs which usually aren't very well researched. This is a question
which I struggle with cause whenever I am on an antidepressant I don't know what kind of supplement I can keep taking. I'd have thought that taking tryptophane with a TCA is
highly dangerous. It surprises me that you did this.
I take whey protein and amino acid pills and I'm not even sure if I could take this when I'm on stablon which I also think about trying.

[nowayout]

I agree. Dubious supplements (and they are pretty much all dubious) at best muddy the waters and at worst can be dangerous.

[Atropy]

Its way to early to tell. Way to early. Tolereance is extremely unlikely. Practice sleep hygeine alongside it. The most common reason people fail sleep aids early is they 'fight' them or arent doing normal bed time things.

It doesn't look good from what I gather from online experiences,I know that means a little but this barely functional state sucks.Socially I am a doorknob.

From what I read about user experiences,Moc either works,works for a short while and stops,or doesnt work at all.I think I may fit into the second category.None the less I will give it week more and see what happens,how I feel,but I dont know how it can redeem itself from here.

I have a question for Atropy,

In opening post you named all the meds and supplements you were taking back then. Imipramine + tryptophane and many herbs and so on.
How did you know if that's even safe and possible? Especially when it comes to herbs which usually aren't very well researched. This is a question
which I struggle with cause whenever I am on an antidepressant I don't know what kind of supplement I can keep taking. I'd have thought that taking tryptophane with a TCA is
highly dangerous. It surprises me that you did this.
I take whey protein and amino acid pills and I'm not even sure if I could take this when I'm on stablon which I also think about trying.

I think that Tryptophan is a weak serotonin precursor, but it did help me sleep.I did that at 2 mg.

All those other herbal extracts and supplements seemed like it would not interact with my anti,there are no warning labels on theses herbal products nor did I find any contradictions from online sources.Also,I tried to take everything in low doses to avoid side effects.

Also,I figured that if I found any side effects Id just stop them.I still don't know what I can or cannot take,but I'm taking a break for a while from herbs.

I got allot of advice from Tom.

[dunbar]

You took 2mg L-Trytophan? How did you do that? I mean when you buy it from stores you usually get like 500mg pills.

I'd be really careful especially with herbal supplements and prescription meds. Supplements don't have to be tested for drug interactions. This is a huge disadvantage.
Where I live for example if I buy a vitamin B complex in a pharmacy from a pharma company then it comes with a long leaflet where it says stuff like high dosed B vitamins can
cause this and that issue over a longer period of time and so on. The customer gets all kinds of infos. But when I buy a comparable B complex in the supermarket from a supplement
company then it comes with no leaflet at all! No warnings, no interactions, nothing. That's dangerous imo.

[nowayout]

I'd be really careful especially with herbal supplements and prescription meds. Supplements don't have to be tested for drug interactions. This is a huge disadvantage.
Where I live for example if I buy a vitamin B complex in a pharmacy from a pharma company then it comes with a long leaflet where it says stuff like high dosed B vitamins can
cause this and that issue over a longer period of time and so on. The customer gets all kinds of infos. But when I buy a comparable B complex in the supermarket from a supplement
company then it comes with no leaflet at all! No warnings, no interactions, nothing. That's dangerous imo.

Yes, it is amazing how lax the regulation is in the U.S. For example, if you buy melatonin in South Africa it comes with a pamphlet with a long list of side effects and interactions that nobody in the U.S. buying the stuff off their drugs store shelf has ever heard of.

[dunbar]

That's really an issue. I am not against supplements at all. I just wish they would give you these infos. When you buy a supp and it has no warnings at all you just think it's perfectly safe.
This really sucks.

[Atropy]

I have been on the Moclobemide for 1 day shy of 3 weeks.I presume from what you said that after one more week I should increase the dosage.

Truth be told,my fragile mental state has somewhat started to stabilize a little,so that is a tiny bit promising.
But there is no real increase in mood or depression and social anxiety since 4 days ago,a slight bit yes,but it seems like a superficial increase.

.It certainly is better than taking nothing,that's for sure but Its not good enough and I cant continue being this unproductive,unfocused and depresssed.

My memory is bad too,short term.Long term as well.Focus is down as I mentioned. Wouldn't it be fine me to increase the dosage and still determine effectiveness?

Sleep is still good after fighting it abit.Still taking the trazodone and xanax combo.

My question is ,would it be a ok if I increase the dosage sooner?

[Tom_]

You are lucky to of had a response this quick. I know you dont want to wait but inceasing the dose even at week 4 is unlikely to hurry the response along much. Trazadones 5ht1a patial agonism should soon start to boost the effects. But if you must incease it do so by 150mg.

[Atropy]

It appears so. Ck,Ill see how much more I can take of this,maby I can make it to the 4 week mark,without increasing dosage.Ill see how much I can stomach.Thanks..