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SSRI long term damage/risk thread

ssri serotonin antidepressant anxiety depression attention adhd libido long term

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#61 brainslugged

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Posted 01 June 2013 - 02:43 PM

You are worried about cognitive decline and chose Bupropion of all drugs? Wooow.

There is no long term cognitive decline, though, which is what I am worried about. If I can stop it and return to normal, I don't care as much considering I currently only have one class to do work for, and it is not mentally challenging.

As far as I know, most of the negative side effects are from blocking the nACh receptors, right?

It has it's very own problems though. With a BMI of 18, I would be seriously worried about its appetite-suppressing tendencies. It has also has a way of making you OCD without you really noticing it, at first. Finally, it has the odd report of memory issues.

Considering that I have no appetite normally, I am not too worried about it. I have to and always have had to force myself to eat, so it just comes down to willpower. I was better able to eat on ritalin than without it not because of appetite, but because I had stronger willpower to force myself to eat.

I only have appetite when I have unique options such as when traveling. Otherwise, I rarely get hungry and most food is unappealing, and I only eat for function. The only times when I desire food are extremely salty foods or sweet foods, and I obviously cannot eat those often due to the fact that they are both bad for health.

You can also always just pretend to take them...Personally, I would give it a shot thoyugh.

Thanks for the advice. Yeah, I don't do well at telling lies, so pretending to take them would probably be a bad idea.

As long as it doesn't leave me permanently screwed over, I am fine with it. I am just afraid that it will.

That's a recipe for disaster. Relationships can, do and will break apart at which point the in-person support network is most critical.

That is true. I don't plan on actually doing it, it would be extremely difficult anyway. It would probably be easier to just fix the problems.

I am a male and I really do not get that whole but it will lower my libido concern - especially not if you are single, anyway. I can see why ED would be an issue but lowered libido?

The concern is long term loss. Honestly, I don't even care that much if I was impotent for now, but I don't want reduced libido for the rest of my life.

Edited by brainslugged, 01 June 2013 - 02:46 PM.


#62 nowayout

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Posted 01 June 2013 - 03:07 PM

I am a male and I really do not get that whole but it will lower my libido concern - especially not if you are single, anyway. I can see why ED would be an issue but lowered libido?


Lowered libido can make it difficult to impossible to date, thus further increasing the social isolation that is at the root of many of the problems discussed here. It can also damage your self-esteem as a male by undermining your masculinity. It can cause severe psychological problems (shame, loss of confidence) in some men when they have so little arousal that they cannot get or maintain an erection - these problems may be self-perpetuating and add to the burden of the initial depression. It takes away opportunities for pleasure via sex or masturbation in people who are already anhedonic and have few or no other sources of pleasure, thus making life even less worth living.

Edited by nowayout, 01 June 2013 - 03:16 PM.

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#63 nupi

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Posted 01 June 2013 - 03:56 PM

I am a male and I really do not get that whole but it will lower my libido concern - especially not if you are single, anyway. I can see why ED would be an issue but lowered libido?


Lowered libido can make it difficult to impossible to date, thus further increasing the social isolation that is at the root of many of the problems discussed here. It can also damage your self-esteem as a male by undermining your masculinity. It can cause severe psychological problems (shame, loss of confidence) in some men when they have so little arousal that they cannot get or maintain an erection - these problems may be self-perpetuating and add to the burden of the initial depression. It takes away opportunities for pleasure via sex or masturbation in people who are already anhedonic and have few or no other sources of pleasure, thus making life even less worth living.


My fucked up head does make it impossible to date, not the comparably benign side effects from the SSRi. If anything, those make it easier to deal with not being able to date. Arguably, lower libido would actually make it easier to date because you become more outcome independent and more aloof, both of which are more attractive. If your self-esteem is tied to your libido, something is seriously wrong, anyway. I could see how ED would have an impact on self-esteem but low libido and ED need not go hand in hand (otherwise there would be little if any market for Viagra).
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#64 nowayout

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Posted 01 June 2013 - 04:41 PM

Arguably, lower libido would actually make it easier to date because you become more outcome independent and more aloof, both of which are more attractive. If your self-esteem is tied to your libido, something is seriously wrong, anyway. I could see how ED would have an impact on self-esteem but low libido and ED need not go hand in hand (otherwise there would be little if any market for Viagra).


Maybe in the very earliest stages, but afterwards, sooner or later your relationship is going to fail if you are dating someone with higher libido than you (admittedly, this is less a problem for straight men than gay men, but it is still a problem). And that of course assumes the desire to date, which relies of finding people attractive, which won't happen without libido. People who feel asexual don't normally want to date. And of course ED goes along with lack of libido. You misunderstand how PDE inhibitors work. Viagra does not give you an erection. Arousal + Viagra give you one, so without libido, you can take bucketloads of Viagra and nothing will happen. i can tell you that from experience.

Edited by nowayout, 01 June 2013 - 04:44 PM.


#65 nupi

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Posted 01 June 2013 - 08:47 PM

If anything, my threshold for finding girls attractive has declined slightly rather than increased on an SSRI. Also I do not believe for a second that SSRIs really do stop you from being aroused should the circumstances arise. They may lower baseline libido and lead to ED (although more likely it's just anorgasmia), but arousal itself is hardly an issue given the proper circumstances.

Edited by nupi, 01 June 2013 - 08:49 PM.


#66 nowayout

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Posted 01 June 2013 - 09:01 PM

If anything, my threshold for finding girls attractive has declined slightly rather than increased on an SSRI. Also I do not believe for a second that SSRIs really do stop you from being aroused should the circumstances arise. They may lower baseline libido and lead to ED (although more likely it's just anorgasmia), but arousal itself is hardly an issue given the proper circumstances.


If that is your experience, good for you, but you are begging the question of this thread by assuming that the side effects are mild for everyone. There are people both on SSRIs and not on them, but with PSSD, who would strongly disagree with your characterization of attraction, arousal, ED, etc., not being an issue.

Edited by nowayout, 01 June 2013 - 09:03 PM.


#67 nupi

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Posted 02 June 2013 - 08:33 AM

Under some definition of PSSD, I suffered from it for the past 10 years since a course of Venlafaxine (it definitely cured premature ejaculation once and for all and then some). Even so, it is a price I am willing to pay if it means I do not have to deal with my otherwise overly anxious self. Ultimately, the side effects are real, but their impact is merely theoretical: I do not get laid, SSRI or not.

#68 airplanepeanuts

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Posted 02 June 2013 - 09:02 AM

Arguably, lower libido would actually make it easier to date because you become more outcome independent and more aloof, both of which are more attractive.


I don't believe that low libido has any advantages for dating.

#69 Saladface

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Posted 04 June 2013 - 10:27 PM

Not dying, eating, drinking, procreation.

This is what we are built to do. Our entire purpose is to procreate (with survival just being a means to do this). Everything our bodies and brains do are there because they help us survive, and thus help us breed. How can losing this drive because of a medication not be a serious issue?

Whether you don't mind or not personally is completely irrelevant. Losing interest in sex isn't the problem (there are enough people already). The problem is the mechanism by which this happens is likely something significant, and almost certainly not good.

In my experience it isn't just sex drive SSRI's affect, its all drive, motivation.

Re SSRI's making you gain weight, it honestly doesn't matter if they disrupt your metabolism, or make you hungrier. Making you hungrier is likely due to a change in hormones (leptin, ghrelin etc). You won't resist increased hunger long term. The bonus is, if you take a medication that causes weight gain (for whatever reason), weight gain itself causes hormonal changes (decreased leptin sensitivity, increased estrogen -> lower testosterone) which makes it very hard to lose weight for some people even after stopping. In short, being fat makes you fat.

OP I feel your pain re the docs (have experienced it myself). If you don't want to take an SSRI, but feel you need to for them to prescribe other things, pretend you took it. Sure its better you didn't have to do this, but when the doctors are lying / misinformed / inept you have to do what you can to help yourself.
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#70 Babychris

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Posted 16 June 2013 - 12:29 PM

My most unbearable side effect with escitalopram (lexapro in the US) is that I've lost my creativity or at least I don't feel as creative as usual more particularly for music.

AFAIC my libido is not affected that much but I'm on a low dose (5mg). I suspect myself that my major problem is related to dopamine as I feel TERRIBLE when I take selegiline or even when I smoke a cigarette. It could be a skyzophrenia form.

So ISRS is for now not that bad, but not a panacea.

#71 magniloquentc0unt

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Posted 17 June 2013 - 11:03 AM

so, how are you doing with the bupropion?

#72 brainslugged

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Posted 21 June 2013 - 12:44 AM

Not dying, eating, drinking, procreation.

This is what we are built to do. Our entire purpose is to procreate (with survival just being a means to do this). Everything our bodies and brains do are there because they help us survive, and thus help us breed. How can losing this drive because of a medication not be a serious issue?

Whether you don't mind or not personally is completely irrelevant. Losing interest in sex isn't the problem (there are enough people already). The problem is the mechanism by which this happens is likely something significant, and almost certainly not good.

In my experience it isn't just sex drive SSRI's affect, its all drive, motivation.

Re SSRI's making you gain weight, it honestly doesn't matter if they disrupt your metabolism, or make you hungrier. Making you hungrier is likely due to a change in hormones (leptin, ghrelin etc). You won't resist increased hunger long term. The bonus is, if you take a medication that causes weight gain (for whatever reason), weight gain itself causes hormonal changes (decreased leptin sensitivity, increased estrogen -> lower testosterone) which makes it very hard to lose weight for some people even after stopping. In short, being fat makes you fat.

OP I feel your pain re the docs (have experienced it myself). If you don't want to take an SSRI, but feel you need to for them to prescribe other things, pretend you took it. Sure its better you didn't have to do this, but when the doctors are lying / misinformed / inept you have to do what you can to help yourself.


Thanks for your posts. I strongly agree, and they have been helpful.

As for lying, though, it is tough for me. Especially looking at someone who I know is trying to help me and telling them a lie. I kinda feel like "well, they have good intentions in giving me the SSRI. How am I going to let them help me if I don't follow along with their rules?" and I kinda feel bad in a strange way. Still, what must be done must be done. I just feel like they ARE the one who went to medical school, but then it disturbs me when they tell me that anxiety or depression is just a "serotonin deficiency" or when I read about a doctor saying that loss of sex drive is okay because you won't care about it.

I think I am going to try my luck again pretty far in the future, in a larger, more liberal town. Maybe find a specialist.

so, how are you doing with the bupropion?

I stopped the bupropion sunday (didn't take it sunday).

It wasn't great. There were a few positives, but I have been going back and forth on the negatives, and I think they do more damage than the positives help with.

I have to compare it to ritalin because that is the closest thing I have to compare it to.

It gave a very mild, but mostly insignificant effect on concentration. Of course, I wasn't expecting real a stimulant, but this was weak. In fact, it could have very well been placebo. The bottom line was that it wasn't very helpful, even if it was on its own.

I guess its purpose was for anxiety and mood though. It didn't do anything at all to or for anxiety. Anxiety was EXACTLY the same. Mood was a bit brightened, maybe. Truth be told, it was kinda like a bizzare, weak version of ritalin's mood effects and aftereffects, kinda that glowing effect of everything being a little better. It wasn't very strong, but it was certainly there. I will admit that it was kinda nice. I would imagine it would be a great subtle antidepressant. However, it can be replicated to the same effect but greater strength with Ritalin, and ephedrine or pseudoephdrine + piracetam can give a good enough effect to substitute it. Annoyingly, it also had a persistant dulling effect similar to ritalin's, the feeling of being "soulless", but a lot weaker. Maybe dulling is a bad description, it is kinda complacent or something. Just like a "nothing better to do" feeling, but without an increased ability to actually do anything.

I didn't notice any problems with memory, short term or long term. My short term is always bad, but I couldn't tell it actually getting any worse. Was going to test my Digit Span on cambridge, but I have trouble being persistant (normal). The few days I took it, there was no change, though. No change to appetite, either.

There was a negative effect on sleep. I was sleeping horribly. The first few days, I was sleeping for less than 6 hours per night, waking up multiple times, and being tired about 12 hours after waking up. Then I got to where I was sleeping 6 hours, waking up, AND I couldn't go to sleep nor would I get tired. I can sleep perfectly fine with ephedrine and ritalin, so I don't know what the deal was here. I guess nACh antagonism caused it, but you would think they would upregulate after a while, not get worse.

There was also a general negative effect on cognition. I felt like I couldn't think as deeply about things. It is a difficult feeling to describe, but in a certain way, I felt even less focused than normal. Not brain fog in the way I would normally use it (like it is thick or hazy in your brain) but I think I could describe it as brain fog as in if you turn on high-lights in the fog while you are driving. Piracetam + choline actually helped this quite a bit. However, I kept having to up the dosage of piracetam and then added oxiracetam, and it was getting silly and would have been expensive.

Maybe I should have just been patient and gave it another week, but screw it. It didn't seem to be getting any better. I'll just have to tough it out and compensate (CILTEP, racetams) for this upcoming semester. Next semester, I am moving out and to a city and I can try to find another doc.

I will admit, though, the social anxiety does need to be solved, and amphetamine or ritalin probably aren't the best solutions. I will be looking into self-CBT/exposure and fear extinction meds. Reducing anxiety to be able to talk to the doctor properly is a big thing. Once the anxiety is solved, I can deal with the avoidant features and concentration issues independently and without having to lie.

I did get to buy some stablon thanks to a member here. I will be trying that out soon.

You have to believe me, this thread wasn't originally supposed to be a personal blog, lol :D


To Saladface and those of you who have had bad and permanent experiences with SSRIs, I would be interested in your response to Stablon which does the opposite of an SSRI (but through an unknown mechanism).

My most unbearable side effect with escitalopram (lexapro in the US) is that I've lost my creativity or at least I don't feel as creative as usual more particularly for music.

AFAIC my libido is not affected that much but I'm on a low dose (5mg). I suspect myself that my major problem is related to dopamine as I feel TERRIBLE when I take selegiline or even when I smoke a cigarette. It could be a skyzophrenia form.

So ISRS is for now not that bad, but not a panacea.

Sorry to hear about that. Hopefully pharmocology will progress beyond SSRIs soon. Its strange, though, people with schizophrenia normally are helped by nicotine. If the loss in creativity is harmful, maybe you could talk to your doctor about swiching and trying a new med. Maybe you could try inositol (without SSRIs)?

I think that nupi is probably right in a sense, though. For some people SSRIs are sadly the best choice right now.

#73 Saladface

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Posted 21 June 2013 - 02:03 AM

Re Stablon, would love to try it but sadly, as I am in the UK there isn't a chance :(

My last visit to the psychiatrist here was in Jan, and it was terrible. Despite me saying repeatedly how the SSRI's didn't help me much and have caused significant problems, I was offered... an SSRI. I explained again I didn't want to take an SSRI, and was there any other medication?, she then lied and told me there were only 2 classes of antidepressant, SSRI and Tricyclics, and I couldn't take a Tricyclic because of a minor heart problem (possibly caused when I was on a Tricyclic before for a couple of months ;)). So it was pretty much a 'take an SSRI or gtfo'.

In the UK you can't get prescribed Tianeptine, and you cant get prescribed Bupropion either (unless you are a smoker, for a brief period). Like anywhere they wont touch MAOI's with a 10 foot bargepole. I also tried to get some low dose Selegiline from my GP (just to test whether dopamine is part of my problem) and nope (he hadn't heard of Emsam, nor had his book, so wouldn't prescribe off label).

#74 magniloquentc0unt

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Posted 21 June 2013 - 04:00 PM

doing good on tianeptine, i have the feeling it is very slow but steady. you will definitely need to grow some patience :) afterall, you can not switch out in 2 weeks from a state in which youve been for years.
it is definitely been helping, but not to the amount i (wishfully) expected. No side effects. I m doing particularly better since i combined it with fish oil, uridine, choline, inositol, NAC and DMAE.
Ill keep going, im around my 10th week as of now. aiming for 24

#75 nowayout

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Posted 22 June 2013 - 11:49 AM

doing good on tianeptine, i have the feeling it is very slow but steady. you will definitely need to grow some patience :) afterall, you can not switch out in 2 weeks from a state in which you have been for years


Actually you can. My response to tramadol is pretty much within a couple of hours (tramadol is an opioid plus SNRI, but I suspect the initial resonse is the opioid part).

Ungotunately opioids are not a good long term option, but I am mentioning it as proof of concept. But there are some newer ADs under development based on manipulation of opioid receptors that may have faster onset.

#76 magniloquentc0unt

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Posted 22 June 2013 - 12:32 PM

Yes, and when it wears off, youre back with your former self. What i meant is adjusting perception, uses and customs, and the consolidation of the changes

#77 magniloquentc0unt

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Posted 23 June 2013 - 02:14 PM

Nice thanks for this info.. How would you procede to re upregulate them again? In my personal expeience what you said is absolutely true

#78 magniloquentc0unt

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Posted 23 June 2013 - 03:54 PM

I am taking tianeptine, do you think that this can help in memory problems?

#79 magniloquentc0unt

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Posted 23 June 2013 - 04:22 PM

Thabks for the heads up... I dont think remeron would be good for me, hypersomnia is one of my simptoms.. I still need to improve motivation and energy somehow... And memory and concentration.. I always think of something else and cant focus!!

#80 magniloquentc0unt

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Posted 23 June 2013 - 06:54 PM

Ok tomorrow ill see if i can find!! Btw i have no response to ritalin ... And very weak to modafinil.. But thx again!

#81 magniloquentc0unt

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Posted 23 June 2013 - 07:12 PM

Okay tomorrow when i have a computer ill look calmly into all these substances.. So do you think i should ditch DMAE, NAC, choline and inositol? My therapist gives me the tianeptine so that one must stay.. And te fish oil and uridine works good! Thanks a lot for your time, ill make a post about it when i get to start these supplements and kerp you updated

#82 noos

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Posted 24 June 2013 - 01:22 AM

Anecdotal report of fluoxetine:
It didn't help me at all. It did not brighten up my mood. It elevated my serotonin. Nothing else.
I became an unmotivated, over-eating zombie of a man. Devoid of testosterone or any desires (other than food and sleep).

For me, ampakines and focusing on my hormonal levels have been more effective. This makes me incredibly motivated and much happier.
IMO, happiness is not a state of sedated calm or contentedness that SSRI's bring about. It's a state of excitement and purpose.
The mechanism of action of SSRI's antagonise this state, and bring about a parasympathetic rest-and-relax physiological state.
I took SSRI's for 6 months and had family members do the same. I know people on SSRIs who have continued to take the medication and withered in character and personality as a result.
I can not recommend it. Instead, I think you should address the actual issue (environment, stimuli...) while focusing on performance enhancement, as most diseases are a state of suppressed ability of the body to perform.
I'm just ranting from personal experience, trying to offer something useful.


Which ampakine in particular enhances mood?

#83 brainslugged

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Posted 24 June 2013 - 05:52 AM

doing good on tianeptine, i have the feeling it is very slow but steady. you will definitely need to grow some patience :) afterall, you can not switch out in 2 weeks from a state in which youve been for years.


Patience? I don't have time for that :laugh:

I understand that, having had the underlying social anxiety behavior for all my life, I am not just going to wake up one day and everything be solved. However, I would expect anything that is directly acting to relieve the problem to relieve it in a relatively short amount of time, or at least show progress in relieving the problem.

Some sort of CBT (self or otherwise) will probably be needed in order to train someone like myself from all the missed life-experience and to actually reduce the fears themselves. I agree that some changes must be done over time, because they must be done through experience, and the brain must do them itself.

A major concern with people (like myself) who have had the condition for nearly all their life, however, is that simply covering it with CBT will not be the answer. Assumedly, there is an underlieing dysfunction that has caused the social anxiety to develop. I would expect to see an immediate improvement in that underying symptom upon taking a drug that directly targets the problem. I would expect to see a noticeably growing but gradual change in the symptom with something that helps indirectly (like if SSRIs decrease my 5HT1A density though downregulation and thus help me cope with social situations).

I would prefer as direct an action as possible.

Depression is another matter. My knowledge of depression is limited, but, as I understand, it has a lot more to do with mental "configuration" states than would something like AvPD. Normally depression is a state that is fallen into for long periods of time, but the person can remember a time when they did not have those feelings. I wholeheartedly agree with you in this case. The depression itself is likely not caused primarily by a genetic component. There may be a predisposition to falling into the depressive state, but it isn't likely to be, say, a malfunctioning gene encoding for a specific protein, else the person would be depressed all the time. I think that the greater influence environment has in the issue, the more that gradual change will have to occur, as the medication would only be (theoretically) acting as an aid to recover the old, better state of thought.

For me, though, there is no old, better state of thought. I have always been like this. The social anxiety is only a product of the underlying dysfunction, something difficult to identify but that consists of observable traits. Solving one without the other would be ineffective in the long run. I feel that, if I solve the anxiety without solving the AvPD-like traits, the anxiety will just be conditioned back into me from the negative traits unrelated to the anxiety. Similarly, solving the AvPD, but still being left with social anxiety is going to make very little difference in my behavior.

Stablon seems really neat. I had good effects the first time I took it, yesterday, so maybe that will help me stick to it. Due to expenses, though, I will start it 2x/day next semester.

Serotonin agonists long-term downregulate (decrease) type 2 (5-HT2A/2C) receptors. Long-term serotonin precursors (5-HTP) and serotonin agonists/reuptake inhibitors also will decrease glutamate and acetylcholine levels (since serotonin does this itself), leading to memory problems. Esepecially working memory and spatial memory problems (e.g where did I put my keys, and with direction problems).

Certain SSRIs (prozac is a known one) decrease 5HT1A receptors as well. I didn't know that they also decreased 2A/2C.

I recently read that NMDA antagonism upregulates 5HT1A. It would be interesting to see if NOS inhibition does the same thing. Considering that Methylene blue is serotonergic (having similar effects to a MAOI, not an SSRI) as well as a NOS inhibitor, it could help fight the downregulation on two fronts, both immediate and long-term. Too bad it can't be used alongside an SSRI.

Actually you can. My response to tramadol is pretty much within a couple of hours (tramadol is an opioid plus SNRI, but I suspect the initial resonse is the opioid part).

Ungotunately opioids are not a good long term option, but I am mentioning it as proof of concept. But there are some newer ADs under development based on manipulation of opioid receptors that may have faster onset.

This reminds me, what about Kratom? I am not planning on using it soon, but it could be useful for you. Fortunately, both NMDA antagonism and NOS inhibition are well-documented to reduce mu-opioid tolerance. MB could NOT be used with tramadol because of risk of serotonin syndrome, but it may be feasible with kratom. Then again, Memantine + tramadol may work just as well or better.

#84 kurdishfella

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Posted 20 October 2022 - 07:07 PM

i dont like drugs that alter your natural state of mind and make you a different person
maois used to be the best but not any longer.

Edited by kurdishfella, 20 October 2022 - 07:20 PM.


#85 kurdishfella

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Posted 16 June 2023 - 10:30 PM

natural medicine should replace those nasty drugs that have a lot of side effects, when i say natural i mean the nutrients that are essential to us that we need to get from food. for example tyrosine in food is used to produce dopamine, tryptophan is used to produce serotonin. so instead of having nasty anti depressants or adhd drugs we can replace them with these two alternatives. i understand it is a way to make money for drug companies who also have ties to the government so the government also makes money but perhaps such things can still be sold and money to be made just selling it in its natural form but classify it as a drug as most people like to get their stuff from the doctors instead of over the counter. all drugs with exeption of critical ones that are needed to survive and not die should be banned.


Edited by kurdishfella, 16 June 2023 - 10:33 PM.


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#86 Mind

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Posted 08 June 2024 - 03:21 PM

In case anyone was unaware, the whole scientific rationale for anti-depressants and the "chemical imbalance" theory of mental illness is mostly fraudulent. Here is a good documentary about the subject.







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