8 replies to this topic

[SOCKY MCSOCKFACE]

I've taken a bunch of different things for them in the past and I think I might need to start taking something again. I'm looking for work and I'm having a lot of trouble coping with the anxiety from it. I've noticed my rumination is way up which I've read is a good predictor of depression relapse and my normal coping mechanisms aren't working. I know moclobemide is stimulating but I've seen it's used for social anxiety and I've read that in long-term use it downregulates beta-adrenoceptors. That would help with anxiety, wouldn't it? Has anyone here had experiences with taking it for a mix of depression and anxiety? How did you feel on it anxiety-wise? How was it for your guts, too? I've had major gut issues with psych meds in the past.

 

If you have any other recs for meds I could get on the NHS that might have better side-effect profiles than what I've tried, please let me know. The stuff I really want to minimise is weight gain, gut issues and tiredness.

 

If you want to know my history and what other meds and reactions I've had, here is a giant wall of TL;DR to tell you:

 

I have a history of atypical depression, sleep all the time, eat all the things, and anxiety (no panic attacks). I've had the depression ever since I can remember and I've always been kinda nervous as a kid but I didn't develop full-blown anxiety until my 20s. This is the stuff I've had for it in the past:

 

Prozac - I was just dumped on this and left to my own devices. It triggered an ED and some really strange behaviour, didn't help my mood at all. 

Citalopram - helped my mood in that it made me stop caring about everything but I slept about 16hrs/day and always felt tired/brain foggy and killed all the sex drive I had, caused moderate weight gain

Sertraline - helped me not care like citalopram, and on a 150mg/day the dopamine effects kicked in and I felt a more normal amount of energy and positive mood, but not only killed my sex drive but made sex really painful, caused massive weight gain, and possibly triggered insane and disabling gut issues, which stuck around after discontinuation and still affect me some today. 

Mirtazapine/Remeron - made me psychotic and constantly crave sugar when I was awake, but also made me sleep for 20hrs straight/day. Did not stick with this.

Duloxetine - I was on this in 2014-15. It solved my permanent tiredness/brainfog/hypersomnia issues completely. Even since coming off it I've been generally better for energy/clarity than I ever remember being in my life. Gained a little weight and minimal sexual side-effects. But it gave me such trouble going to the toilet it was seriously like giving birth to a brick every day. Still got issues with that but nowhere near as bad.  

Prozac again - last half of 2015 I went back on this for 6 months in the hopes it would fix the duloxetine issues without making the sert issues as bad as they were originally (I'd been so ill with it I was paranoid of all SSRIs by then). All it did was give me heartburn that felt like I was John Hurt in the dinnertable scene in Alien and I gained some more weight. 

Beta Blockers just a couple of doses to get through my PhD viva and that worked but I had about 6 weeks afterwards where I felt really down, tired and had no motivation. I don't know if it was the beta blockers or stress-hangover, but it's made me reluctant to take them regularly for anxiety while I'm looking for work.

 

Outside of meds, I run and lift weights, I try to eat as well as I can. I've had all the therapy the NHS is willing to give me and I can't afford to go private so I'm stuck with what drugs my GP and possibly pdoc, if I can get re-referred to the psych service, will prescribe me. 

 

Thanks ever so much anyone making their way through that.

[Finn]

Duloxetine - I was on this in 2014-15. It solved my permanent tiredness/brainfog/hypersomnia issues completely. Even since coming off it I've been generally better for energy/clarity than I ever remember being in my life. Gained a little weight and minimal sexual side-effects. But it gave me such trouble going to the toilet it was seriously like giving birth to a brick every day. Still got issues with that but nowhere near as bad.  

 

 

 

Since duloxetine is SNRI, increase in noradrenaline could enlarge prostate, which could then make urination or defecation harder.  This side effect could be treated with benign prostatic hyperplasia medications like tamsulosin, which is a selective α1 receptor antagonist that has preferential selectivity for the α1A receptor in the prostate versus the α1B receptor in the blood vessels, so it shouldn't cause hypo tension issues. 

 

Edited by Finn, 23 November 2016 - 05:08 AM.

[SOCKY MCSOCKFACE]

 

Duloxetine - I was on this in 2014-15. It solved my permanent tiredness/brainfog/hypersomnia issues completely. Even since coming off it I've been generally better for energy/clarity than I ever remember being in my life. Gained a little weight and minimal sexual side-effects. But it gave me such trouble going to the toilet it was seriously like giving birth to a brick every day. Still got issues with that but nowhere near as bad.  

 

 

 

Since duloxetine is SNRI, increase in noradrenaline could enlarge prostate, which could then make urination or defecation harder.  This side effect could be treated with benign prostatic hyperplasia medications like tamsulosin, which is a selective α1 receptor antagonist that has preferential selectivity for the α1A receptor in the prostate versus the α1B receptor in the blood vessels, so it shouldn't cause hypo tension issues. 

 

 

I'm female (probably should've said, sorry) but would that cause the same issues with skene glands? It definitely made full urination harder when I was on it but that issue stopped as soon as I came off it. I feel like it definitely slowed down my gut transit time though, I figured it was some sort of anticholinergic effect from the norepi reuptake blocking.

[Finn]

Same adrenoreceptors are apparently present in other parts of urinary tract, it seems α1-blockers have helped some women and men without prostate issues, if increase in noradrenaline levels causes urinary tract issues, α1-blockers might help.

 

 

 

https://www.ncbi.nlm...les/PMC3989821/

 

 In addition, it is now clear that mechanisms besides prostate smooth muscle relaxation are involved in therapeutic effects of α1-blockers.[12] These may include actions on the bladder microcirculation, and α1-adrenoceptors in the urothelium, in afferent nerves, or in bladder smooth muscle.[12] In fact, α1-blockers may improve symptoms in women, in men without BPO (benign prostatic obstruction), or in animal models, where a prostate-dependent contribution can be excluded.[8,13,14,15]

 

 

https://www.ncbi.nlm...ubmed/18295277/

 

Terazosin therapy for patients with female lower urinary tract symptoms: a randomized, double-blind, placebo controlled trial.

Edited by Finn, 23 November 2016 - 11:37 AM.

[Mind_Paralysis]

Hmm... tricky!

 

My natural inclination is Duloxetine, since SNRI's were recently proven in a wast Metareview to be the most effective medications for the long-term treatment of anxiety disorders. And Duloxetine has also been proven to be somewhat more effective in GAD than Venlafaxine, so hence, I figure Duloxetine is better than Venlafaxine.

 

The fact that it messes with your bladder is a problem though... HOWEVER...! Finn just potentially SOLVED that problem! : D

 

So, hence, I recommend you go back to Duloxetine again, but with Terazosin as an adjunct, to get rid of that side-effect.

 

 

That's some good referencin' there Finn! = ) You continously impress me with your knowledge, dude.

 

 

EDIT:

 

Btw, SOCKY MCSOCKFACE, have you tried supplementing with Magnesium any? I'm thinking, since you seem to have a lot of anxiety, that perhaps NMDA-receptor malfunction could be involved in your case as well, yes? (and not just serotonergic) Some people have had good results with Magnesium-L-Threonate, so some bioavailable magnesium-compound might be useful in your case - but only as an adjunct, to enhance anxiolytic action even further.

 

 

References:

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

Efficacy of treatments for anxiety disorders: A meta-analysis

https://www.research...A_meta-analysis

 

(see figure 2. in the enclosed study)

Edited by Stinkorninjor, 23 November 2016 - 09:33 PM.

[SOCKY MCSOCKFACE]

I don't know anything at all about NMDA receptors. Will need to do some reading, but I've got some cheap magnesium (citrate, I think) that I can try now. I did use it when I was on duloxetine for the gut issues and didn't get much relief there but I wasn't paying any attention to how it affected my mood so it's definitely worth testing. Would stacking it with phenylalanine increase the effect since I know citrate isn't that bioavailable and phenylalanine binds at the glycine site?

[Finn]

 

 

 I feel like it definitely slowed down my gut transit time though, I figured it was some sort of anticholinergic effect from the norepi reuptake blocking.

 

Duloxetine isn't really anticholinergic, which is overall considered advantage since anticholinergic side effects can be nasty. Gut transit time slow down is probably due to extra norepinephrine affecting also alpha 1 receptors of gastrointestinal tract sphincters like it does urinary tract sphincters. So alpha 1 antagonist should help with over activity of both urinary and gastrointestinal sphincters. Anticholinergic gut transit slow down works through other route.

 

 

 

http://www.physiolog.../adrenergic.htm

 

Increased activity (muscle tone) in urinary and gastrointestinal sphincters reduces the passage of contents past them.

 

http://www.healthlin...rgics#Druglist2

 

 

Anticholinergics block acetylcholine from binding to its receptors on certain nerve cells. They inhibit parasympathetic nerve impulses. These nerve impulses are responsible for involuntarily muscle movements in the gastrointestinal tract, lungs, urinary tract, and other parts of your body. The nerve impulses help control functions such as salivation, digestion, urination, and mucus secretion. Blocking acetylcholine signals can decrease involuntary movement, digestion, and mucus secretion. If you take an anticholinergic, you may retain urine and experience dry mouth.

Edited by Finn, 26 November 2016 - 08:48 PM.

[Mind_Paralysis]

I don't know anything at all about NMDA receptors. Will need to do some reading, but I've got some cheap magnesium (citrate, I think) that I can try now. I did use it when I was on duloxetine for the gut issues and didn't get much relief there but I wasn't paying any attention to how it affected my mood so it's definitely worth testing. Would stacking it with phenylalanine increase the effect since I know citrate isn't that bioavailable and phenylalanine binds at the glycine site?

 

Citrate is actually one of the better compounds, so yeah, high dosage with that might be worth it.

 

I actually start getting diarrhoea from the higher dosages of that, so perhaps you'll notice relief from Duloxetine-induced constipation at higher dosages.

 

 

I must admit to not having ANY idea if Phenylalanine will alter MgCitrate bioavailability! I tried to look it up with some studies, wherein the binding-sites of magnesium was discerned when it comes to binding directly to organic molecules(!) stuff like RNA and DNA - I ended up mostly confused.

 

Regarding general bioavailability of Mag-compounds, there's this entire thread of it on Longecity:

 

http://www.longecity...agnesium-types/

 

Quite a long and not easily-settled debate... In general though, organic compounds of Mag seems to be better, at least that's my IMHO of the available science - hence, Citrate is pretty good.

[Dinohead]

I've been nearly everything for my anxiety and depression ssri, tca, mood stabilisers, neuroleptics, maoi (real ones).
I actually liked moclob, tho most say it's weak and ineffective. It felt like someone had turned the lights back on and the world was a brighter place.
In the end tho the insomnia and a fatigue set in I couldn't cope with.
My fav drugs in my journey have been
Lamictal 50-100mg
Amisulrpide 50mg be careful of dopamine increasing drugs and funny sides. Instant antidepressant effect.
Tianeptine but only when I was in France.