13 replies to this topic

[JvA]

Hello, loved Longecity forum members!

Super short version
I understand this text is long. If you don't have the patience to read it all, I understand. I'll try to sum my problem up:
Escitalopram fixes my social anxiety/empathy/Asperger-like problems and seems to give me better overall memory, and my short term verbal memory is normally really bad. However, it gives me much less pleasurable orgasms and affect sleep. Any idea how to fix that?

Background
I'm diagnosed with ADHD (but might very well also have some Asperger going on) and for the last 3,5 years I've been on several kinds of stimulants. Tried most available methylphenidate based medications, but they mostly gave negative side effects, like strong anxiety and complete lack of social skills. It was like it removed my ability to think. Moving on to today, I've been using amphetamine-based stimulants for the last 1,5 year. I've tried short acting generic dextroamphetamine, Adderall XR and Vyvanse.

Currently, I'm using 20 mg Vyvanse twice a day. It works quite ok. My mind is quiter, but still had some anxiety. The biggest difference I feel using amphetamines compared to methylphenidate, is that I feel normal. Methylphenidate left me in a mental state that felt synthetic, while amphetamines seem to just give a "natural" feeling mental boost.

Since the start of using any stimulant 3,5 years ago I've experienced quite a lot of muscle tension. Especially in my shoulder blades and shoulders. Doing physiotherapy, building muscle and exercise in general seems to help. Also, ingesting at least 100-125% of the RDI of magnesium as magnesium glycinate, seems to help a lot.

After some thought I suggested to my doctor that we either try Wellbutrin XR (Buprion) or Cipralex (Escitalopram) as addition to my current medications, because I thought one of those might lower the muscle tension I've felt and perhaps also lower some anxiety that I get from the amphetamine. He wrote me a script for both and told me to try one of them at a time for at least 2-3 weeks, at a dosage I chose myself. After doing more research, looking into what has worked for relatives, I chose to try the Escitalopram first. Especially since my mother is on Concerta and Citalopram, and that seems to work like gold for her.

It worked very well. I began using 2.5 mg Escitalopram in the morning. It had such a big effect that people at work began commenting. It's like it removed some of the rigidness of stimulants and improved my verbal memory, at lot. Suddenly, they experienced me as easy going, funny and emphatic. I have to strongly agree with them. For the first time in my life I actually felt compassion and a sense of belonging towards other people. Not feeling like an alien. It suddenly was so extremely easy to actually care about people, making small talk, making small jokes etc. Now you should know, Swedish people (I'm Swedish) are much less social compared to people in the US, so even if this small talk is a small step, it's a HUGE improvement for my general well being. It actually feels meaningful to hang out with people now. I've always struggled with communication, giving and taking in a conversation, especially if the group is larger than two people. With 2.5 mg Escitalopram it's almost effortless. The best part: this is something other people tell me they've noticed about me! I've also noticed I actually can sit still and relax at home. Like... reading a book. That's awesome.

Problems
The combination of Vyvanse, Agomelatine and Cipralex gives a lot of positive effects, but also some negative ones. If I at least could solve the sexual side effect, this combo would be golden for me. I understand SSRIs can stop working down the road, but at least for now, it gives me a boost so I can start working on my social issues.

• The Escitalopram seems to interfere with the Agomelatine. I've always suffered from delayed sleep syndrome, having a feeling of a 25 or 26 h day. Agomelatine fixed that. Escitalopram seems to unfix it. Taking Escitalopram at night seems to partly solve it again, but it stills seems to negatively affect sleep.
  
  Any other ideas how to improve this?
  
  
• Escitalopram, even at such low dosage, strongly affect my sex life. Orgasms are much less pleasurable. This is a BIG problem! I don't want orgasms feeling almost like nothing. Lowering the dosage to 1.25 mg a day helps in that area but removes the pro-social effect.
  
  Any tip how to proceed here?
  
  
• I feel like Escitalopram makes me care less about actually work hard, at work? Perhaps it's a positive thing, but still.
  
  Is this common?
  
  
• According to my liver tests, I have elevated albumin. I've read it hooks to testosterone, lowering sex drive. I think Agomelatine caused it, because I had it before introducing Escitalopram, but then I still had a strong sex drive?

Supplements and medications
My current stack for general health and ADHD.

In the morning
1x 20 mg Vyvanse
1x 2000 IU Vitamin D softgel
1x Jarrow Formulas, CarotenALL, Mixed Carotenoid Complex softgel
1x Life Extension, Super K with Advanced K2 Complex
1x Now Foods Tri-3D Omega softgel
0.5x Now Foods, B-50 tablet
1-2x Doctor's Best, Magnesium, High Absorption, 100% Chelated tablet

Mid day
1x Doctor's Best, Magnesium, High Absorption, 100% Chelated tablet

In the evening/night
1.5x 25 mg Valdoxan (agomelatine)
1x Doctor's Best, Magnesium, High Absorption, 100% Chelated tablet
1x 1 g Taurine capsule
1x 250 mg UMP (Uridine-5-Phosphate) capsule
0.25x 5 mg Escitalopram tablet

Edited by JvA, 12 May 2013 - 12:02 PM.

[JvA]

I've since the posting increased the Escitalopram to 2.5 mg. The 1.25 mg proved to be to little to get rid of the worst anxiety.

However, it also turns out that the quality of my short term memory varies a lot, from day to day. Some days, it feels like my mind is racing, even though I'm on stimulants. On other days I feel quite focused. I thought a lot about it. Since I almost always have a very dry nose, dry mouth and a dry throat, I first thought it's just side effects from the stimulants. Perhaps. Or... could it be a vitamin A deficiency? But hold on! I'm already eating "Jarrow Formulas, CarotenALL, Mixed Carotenoid Complex softgel", so I should be getting 2500 IU of vitamin A. What more things has to do with the mucous membranes? Acetylcholine!

Acetylcholine is extremely important for the memory. Having a deficiency in choline probably would make anyone feel a bit foggy minded. If you also, like me, have the combined type of ADHD (inattentive and hyperactive), you might also be at risk at having a Choline transporter gene variation, according to this study:
http://www.ncbi.nlm....les/PMC3164006/

These studies show evidence of cholinergic deficits in ADHD, particularly for subjects with the Combined subtype, and, if replicated, may encourage further consideration of cholinergic agonist therapy in the disorder.

I've tried to eat more eggs to get more choline in my system, but I seem to get a lot of gases from eggs. And I find it very hard to eat more than 1-2 eggs per day, often resulting in less than that. My appetite isn't the greatest to begin with, thanks to the amphetamine, but with an egg or two, it totally kills it. Long story short: I tried 500 mg Citicoline (Healthy Origins, Cognizin) today. Wow! Within an hour I started feeling the difference, and it was huge. I feel much more present minded, and my mouth isn't as dry anymore. It's suddenly so much easier to keep focused on one thing, instead of having a scattered mind. Let's hope this effect isn't placebo.

[nupi]

I feel like Escitalopram makes me care less about actually work hard, at work? Perhaps it's a positive thing, but still.

It's because of the lowered anxiety. I find it suprising that 2.5mg Escitalopram would have the effect. I could barely feel 5mg (Escitalopram always had a definite come on and off for me) and once reaching 10mg, it definitely did do something but it also made me incredibly tired. Overall, I am having better results with Fluoxetine which is much smoother due to its ridiculously long half life, might be worth a try.

Neither Fluoxetine nor Escitalopram really ever eliminated my social anxiety, though.

[nowayout]

For the sexual side effects, adding Remeron or Wellbutrin may help.

[nupi]

I would be somewhat cautious with stacking stimulants and Wellbutrin. Also Wellbutrin is probably not the best option if anxiety is a consideration....

[nowayout]

I would be somewhat cautious with stacking stimulants and Wellbutrin. Also Wellbutrin is probably not the best option if anxiety is a consideration....

Remeron then.

[nupi]

Isn't that more of a sedating AD?

[nowayout]

Isn't that more of a sedating AD?

A lot of people say it is only sedating at low doses, not antidepressant doses.

For me it not in the least sedating at any dose (unfortunately). The sedation wears off in one day and then my insomnia is back in force.

In any case, it is a non-stimulating AD that is sometimes combined with SSRIs or SNRIs to counteract sexual and other side effects of the latter.

See also "California rocket fuel."

[Sunwind]

Did Escitalopram fix your social anxiety on its own or do you think it was a combination of that with something else? I currently take 225mg Venlafaxine for social anxiety (and depression as a result of the anxiety), and while it seems to work great for treating the depression, it doesn't seem to help very much for my anxiety. The only things that help are drugs with a strong effect like phenibut (4g+ dose, but I can only do it once a week) or benzos, which I don't like taking because they fuck your memory up. Alcohol works too, but fuck that.

If Escitalopram is good for social anxiety i'll ask my doctor to switch to that, I saw it mentioned in the "how to safely treat anxiety" thread.

Edited by Sunwind, 25 May 2013 - 09:01 PM.

[nupi]

It likely has a better chance at treating anxiety as the NRI activity of Venlafaxine can be anxiogenic. Personally I much prefer Fluoxetine to Escitalopram but it is definitely a good place to start with in case you want to move to an SSRI (it is likely the purest SSRI we have)

[JvA]

Thanks for all your replies!

Since the original posting and the post about Citicoline, I've noticed that Citicoline seems a bit tricky. Some days it gives lots of headache, while other days it works just fine

Any tip if I might be missing some co-factors, like B-vitamins? Too little water?

For the sexual side effects, adding Remeron or Wellbutrin may help.

I've tried Remeron in the past together with Dexedrine. First in a low dosage to help with sleep, later with a higher dosage. I slept good, but was also always tired. Secondly, a higher dosage gave me an extreme restlessness.

Wellbutrin, yes it might help, but could also cause cramps as it lowers cramp threshold and this risk increases, if I've understood it right, with addition of another stimulant like Vyvanse.

I've tried Wellbutrin alone for 2 months some years ago. I didn't notice anything. It was like eating a sugar pill. The dosage I tried was 150 mg.

Did Escitalopram fix your social anxiety on its own or do you think it was a combination of that with something else? I currently take 225mg Venlafaxine for social anxiety (and depression as a result of the anxiety), and while it seems to work great for treating the depression, it doesn't seem to help very much for my anxiety. The only things that help are drugs with a strong effect like phenibut (4g+ dose, but I can only do it once a week) or benzos, which I don't like taking because they fuck your memory up. Alcohol works too, but fuck that.

If Escitalopram is good for social anxiety i'll ask my doctor to switch to that, I saw it mentioned in the "how to safely treat anxiety" thread.

Yes I think it did. However, I've never used Escitalopram on it's own, always with an amphetamine in my body (generic dexro, Adderall XR or Vyvanse). What I've noticed from Escitalopram is that it seems to give a peace all day long. With just amphetamine I have a hard time sitting down reading a book. Combining with Escitalopram makes me more at ease.

It likely has a better chance at treating anxiety as the NRI activity of Venlafaxine can be anxiogenic. Personally I much prefer Fluoxetine to Escitalopram but it is definitely a good place to start with in case you want to move to an SSRI (it is likely the purest SSRI we have)

I'll look into that if the Escitalopram doesn't work out.

Edited by JvA, 26 May 2013 - 12:42 PM.

[Raptor87]

Increasing norepinephirine, (intermittent fasting- green tea) or (yohimbine) would do the trick for your little buddy. Although dont go overboard with that shit, chronic masturbation can fuck you up. Also I went on mb marathons when on modafinil but then later came impotence for almost 3 weeks that messed my head up because I didnt know what was going on. Now I am back to normal:/

I am glad that you found something that works. Remember that it can take a few months before your boners come back when on srri's so if you just started your treatment then I would advice you to wait before starting a bonerregime.

[protoject]

You might consider pregabalin for sleep. I'm a hardcore insomniac who sleeps worse than every single person I've met, and pregabalin has stabilized my sleep, giving me at least 5 hours of solid sleep a night (which is amazing for me), makes it a lot easier to fall asleep.

Of course I'm not sure if this will counteract the sleep-disturbing effects of the SSRI....

but I have some escitalopram and have been scared to take it, but im hearing good things so I am considering trying it. Maybe with me experimenting on myself we can come up with some data on whether pregabalin works for sleep issues related to escitalopram- haha!

[THP]

This is a very old topic, so apologies, but I have something to add which may help.

 

I tried Agomelatine, after it being 'sold' to me because it had no sexual side effects. For me, this was not the case. It lowered libido, and made orgasm much less pleasurable. This may be an unusual response, but there are other reports online and a drug very closely related to it, Rozerem, often causes low libido too because of its affect on melatonin which can lower testosterone. 

 

Vyvanse and amphetamines leave my libido intact, and sometimes increase it but like agomelatine leave orgasm much less pleasurable or even pleasureless depending on dose. So, I think that for some of us (and this is just a guess) medications which increase dopamine leave the body less able to release that all important rush at orgasm, because our brains are already awash with dopamine and pleasure is reduced. 

 

Interestingly, when I added low dose escitalopram (2.5 - 5mg) pleasure returned to orgasm very intensely. But cruely, libido decreased (but only a little because my dose was kept low.) By this time however I had discontinued the agomelatine.

 

The OP was on two meds with action on dopamine, and coupled with the melatonin action from agomelatine it killed pleasure. Either discontinuing the agomelatine, or increasing the escitalopram might have helped. Again, just my hunch after my own experiences.

 

I'm not sure if anyone is looking at this topic at all anymore, but did the low dose escitalopram work out for people? Any weight gain? Sexual side effects on a low dose, and did they get better after a while? Like I said above, mine is helping with pleasure but reducing libido and I'm hoping this will improve.

Edited by THP, 18 June 2015 - 09:34 AM.