56 replies to this topic

[magniloquentc0unt]

Hi everyone.
I've been trying different meds over the years, and nothing has helped more than the SSRI (prozac) for concentration, ability to follow one task, understanding and just simply good flow of toughts.
i took the fluoxetine for dysthimia with melancholic features, and was somehow unaware of my poor cognition till then. I took it for 8months that wrecked my libido and which is still not 100% now, 4 years later.
After that i tought that "fluoxetine has numbed my emotions". I am not sure of that now, it might be, but it might also be that it helped me feel emotions, and when i went off SSR (did couple of MDMAs over that period)I, i kind of forgot i might have not had "full emotive spectrum" beforehand. I just dont know for sure, as of now. Anyhow, after a couple of years, i went to the shrink again and got diagnosed with ADD, we tried methylphenidate which had no effect whatsoever, and modafinil was "meh", just made me feel strange with no cognitive boost. I have now been on tianeptine for a while and i feel it has helped a bit on emotionality but not on energy and cognition, not at all. What i deduce from my experience is that dopaminergics (like tianeptine is, mildly increases dopa release in some brain areas) are not my magic buller, but serotonin might be....
Im not really sure what im asking from you guys, probably an opinion on what to try out next... i was thinking of moclobemide.

[Tom_]

I would suggest a trial of low dose buspirone and reboxetine.

[nupi]

Did you get a hormone panel?

[magniloquentc0unt]

I would suggest a trial of low dose buspirone and reboxetine.

thanks for the suggestion, unfortunately buspar is not available where i live since a couple of years, and i want to let my health insurance pay this time... (i paid for the six months tianeptine with my own money.. wasnt cheap).
Doesent Reboxetine cause sexual dysfunction? that field really is a 100% no go for me.

[magniloquentc0unt]

Did you get a hormone panel?

hi nupi, yes i did, multiple times over the last years, everything came out fine, maybe a bit on the low side. Hemoglobin is maybe a bit low, but thats probably because of my thalassemia which causes me to have a few less red blood cells. Even had a MRI with contrast and came out fine, no misterious pituary aberrations

[nupi]

You may want to dig a little further in the hormone panels (Esp for Testosterone) as what is considered to be within normal range hardly is healthy at the lower bounds (or at higher bounds, for some of the others). There's a fair bit of quack science going around at medicinal labs, to be damn sure (averaging over the whole population to establish acceptable ranges and similar bullshit).

[magniloquentc0unt]

You may want to dig a little further in the hormone panels (Esp for Testosterone) as what is considered to be within normal range hardly is healthy at the lower bounds (or at higher bounds, for some of the others). There's a fair bit of quack science going around at medicinal labs, to be damn sure (averaging over the whole population to establish acceptable ranges and similar bullshit).

yes, testosterone was on the low end, i can remember that for sure. unfortunately i dont have the precise numbers at hand, and personally im a bit skeptic when thinking of starting testosterone augmentation when still in my late 20s...
what has been interesting me lately is moclobemide, which is used a lot here in switzerland and also as a first(and a half) line treatment, substantially increases testosterone in depressed males. that might be killing two birds with one stone

[nupi]

If it's on the low end, you are a definite candidate for TRT: http://www.mens-horm...els-in-men.html (IIRC, the low end on my lab report was more or less the average for 75+)

Coincidentally, I will see my doc for this exact topic tomorrow (took blood samples on Friday). Seeing that he wants me to get off Fluoxetine (on principle I guess, as I don't have any truly bothersome side effects). However, unlike you, I have precisely 0 qualms about getting on TRT should the levels be as low as I fear they might.

Do you have a source for the T increase with Moclobemide?

I just digged out my last, 2 year old hormone panel and low and behold, Albumin and TSH are above the reference values (even if only slightly). If this got any worse, I will sue my old GP for not taking action. My total T is in the 65-75 year range.

Edited by nupi, 30 September 2013 - 05:15 PM.

[magniloquentc0unt]

http://europepmc.org...n00052-0039.pdf

"The administration of multiple doses of moclobemide to depressed male patients caused a significant rise in plasma
testosterone. This stimulatory effect is unlikely to be mediated by the hypothalamo-hypophyseal axis, since there was
no concomitant change in the luteinizing or follicle stimulating hormone level (Markianos et al 1991)."


http://onlinelibrary...2.tb00229.x/pdf


Neuroendocrine effects
[...] In 12 depressed patients, 400 to 600 mg moclobemide
(administered daily over 4 weeks) produced a significant increase in plasma testosterone,
but failed to alter plasma levels of prolactin, LH or FSH (106). Moreover, daytime plasma
melatonin levels were not changed in healthy subjects taking single oral doses of moclobemide
(146).

here the sources... testosterone really is a big concern actually, i think it is hard to describe ones own situation accurately over the internet, but I do feel too that theres some sort of native Beta manliness, low testosterone feature haunting me

oh, and of course let me know how it goes with your doc, i too have an appointment pretty soon...

[nupi]

Oh in my case it's more omega than beta at least when it comes to women - I have surprisingly little issue with taking people way more senior than me to task if I feel I have a case.

But at least with the SSRI, it's not really haunting me. Too little, if anything, still, given the choice of SSRI or the prior situation, my choice is very clear. With the ridiculous (handy while you are on it) long life of Fluoxetine, Moclobemide is not really an option right now, either way.

Edited by nupi, 30 September 2013 - 05:25 PM.

[nupi]

Kind of not so useful to have the lab not report the hormone figures in time. Ah well, another attempt on Friday

[magniloquentc0unt]

and in the meantime, insurance pays, you lose time and doc earns his money... wonder what you talked of... was it a shrink or just normal doc?
btw, from personal experience, i can say that fluoxetine made me a submissive whimp even more than i already was, so maybe getting rid of it will help... unfortunately the situation did not change much, but i feel the tiantptine ive been on for the past 6 months helped me in that sense. It is, probably, very serotonin related... Which would make one think moclobemide is not a good choice for aforementioned reasons... yet the reports all agree that it increases conflict oriented behaviour, so to say

[nupi]

He's nominally internal medicine but quite into mind-body interactions (probably right fully so, especially in this case).

Some of it is a little esoteric but everyone who's first action is to suggest I take 2000IU D3 and probiotics and then wants to put me on a HIIT protocol to improve fitness gets a significant increase in his budget to throw weird ideas at me. In any case, he's about an order of magnitude better at playing shrink than all of the proper shrinks I've come across so far. And also, he seems like the first doc in a long time who actually accepts what I tell him (it may or may not help that I got a referral from an MD at a my place of work and that he knows the type of people working there). Certainly much different than my GP whom I had to pretty much force into getting me a hormone panel 2 years ago and who even went as far as refusing to give me sick leave documents after the meds he prescribed me knocked me out for 2 weeks last year.

As for the insurance pays another hour (or ten), who cares. Especially after they twisted my arm to get full on private coverage because otherwise coverage abroad would not have been good enough for my extensive travels at the time. It's also chickenshit compared to what even a single night in hospital costs.

Edited by nupi, 01 October 2013 - 05:23 PM.

[nupi]

Just got the results back (signed a waiver for them to be emailed ,
total T at 20.8nmol/l which is not spectacular (like age 50ish) but not thaaaat bad
Nooow, free T (unfortunately without indication of the way they got to it): 39.9 pmol/l (on a 34-118.3 range). Sounds like we got a thing there. Does anybody have age adjusted free T ranges? Edit: http://www.mens-horm...els-in-men.html shows a 400pmol/l value for my age group (and even the oldest group has a mean above what the lab quotes as reference range, are they per chance off by an order of magnitude)???

(FSH and Lutropin are in the lower quartile of their respective ranges, too, need to figure out what that means).

Edited by nupi, 02 October 2013 - 03:43 PM.

[jadamgo]

Uh oh, you've got an excess of sex-hormone binding globulin. Anybody here know how to fix that? I can spot the problem but I'm not familiar enough with sex hormones to know what to do about it.

[nupi]

Agreed but what is a bit irritating is that the lab did not test for SHBG specifically. Oh well, slated to have a discussion with the doc in half an hour... Still, the relatively low FSH and LH could point to something else, as too.

[nupi]

So the doc was a bit lost but promised to do some research.

Meanwhile, I had a major facepalm when searching my 23andme reports for SHBG (not sure how I could miss that):

rs727428 CC On average, about 12% higher levels of circulating SHBG in postmenopausal women.

I would not be surprised if there were negative effects for men, too.

Worse:

rs1799941 AA On average, about 27% higher than typical levels of circulating SHBG

As for total T, one of the SNP tests as average, the other one as slightly below average which is corrobated by the report.

I need to see an endo.

Edited by nupi, 04 October 2013 - 05:09 PM.

[nupi]

Some more insights:
In Testosterone for life, free T is considered as treatment indication at below 15pg/ml (50 for calculated free T):

In my practice, free T concentrations below 15 pg/mL are
considered consistent with low T when determined by the analog
free T test (this is almost always the test performed when the
physician orders free T). For free T determined by equilibrium
dialysis or calculated free T, values below 50 pg/mL are considered
to be low.

As 40pmol/l are about 11.5pg/ml, I think it's clear something is amiss.

Also the Vermeulen figures on mens hormonal health look like BS to me (doing the calculation by hand, I get much different levels than he does, too).

I have requested to get SHBG figures as well (so I can do calculated free T) and will call the lab on Monday to try and figure out which exact immunoassay they used and see if I can get some details on population stats of that assay.

[magniloquentc0unt]

so, my shrink suggested i try moclobemide next. without me ever mentioning it. thats not bad... im only worried of eventual SSRI-analogue side effects like emotional blunting and apathy...

[nupi]

Ok so I did get SHBG measured on the same blood sample and now I am truly confused:

My measured free T comes in at 39.9 pmol/l (equiv. 11.5pg/ml)
My calculated free T comes in at 464pmol/l (equiv. 134pg/ml), almost 12 times higher

In Testosterone for Life, Morgentaler states:

“Despite all this emphasis on total T, there is general agreement that free T is more important, due to the possibility that high SHBG tends to make total T appear normal.[…] In my practice, free T concentrations below 15 pg/mL are considered consistent with low T when determined by the analog free T test (this is almost always the test performed when the physician orders free T). For free T determined by equilibrium dialysis or calculated free T values below 50 pg/mL are considered to be low.” (p. 71)

So which is it (safe to say the doc says "no TRT for you, but feel free to dabble with [the usual herbs]")? And why the humongous difference, far in excess of what it should be even allowing for different measurement methods?

Edited by nupi, 09 October 2013 - 05:43 PM.

[Wu Hang]

Very interesting thread.

I am not sure if it is the case, but if T level is low, wouldn't it affect the dopamine concentration, thus causing those dopaminergic medication not to work? if that's the case, I doubt changing your serotonin level would change the situation, since the main problem is your sex hormone. I don't think a single medication would magically work in this case, maybe enhancing the body physique would work better in this case

[magniloquentc0unt]

just got my lab reports, 8.1 nmol/L, where range would be 9.3-36.5 ....how cool is that

[magniloquentc0unt]

does anyone know is Tianeptine can cause a lowering of testosterone? Was on it for the past 6 months, and ive found a 1 and a half year analysis where my testosterone was in range, althou low-side

[magniloquentc0unt]

im wondering what comes first.. depression or low testosterone...

[Tom_]

Low testosterone is not a symptom seen in depression!

For men there are mixed results - with a few showing abnormalities but they are just as likely to be high.

In women the link is slightly stronger although still mixed.

Only in HIV, hypogondal or aged people is testosterone shown to be of any significant benefit for depressive disorders - at least so says every metanalysis I've read.

Hypogonadism can cause MDE's but unless there is a clinical endocrine disorder hormones don't play a part in MDD treatment (expect T3 and when better researched drugs decreasing cortisol). Excluding estrogen for certain types of female related depression and testosterone for older men or HIV (maybe all chronic infections?).

[magniloquentc0unt]

so let me get this straight: you would saythat what has to be treated is low testosterone and not depression ?

[Tom_]

If you have clinical hypogonadism and then onset of depression the primary treatment should be with Testosterone and an antidepressant can be used as an adjunct.

You actually do seem to have low T (although I'm not using proper reference rangers and may be wrong).

Either way Moclobremide is a good idea. Talk to a g.p, psychiatrist or endo about T ranges and see if they recommend it.

[nupi]

so let me get this straight: you would saythat what has to be treated is low testosterone and not depression ?

It would seem to be a no brainer to treat low T in my view. Whether it will take care of the depression is another question...

[magniloquentc0unt]

yeah, i was intimidated at the idea of starting TRT at my age, but after all, its unfunded.
i realized the other, older testosterone analysis where the results are higher (and yet extremely low but still in range)
was done a couple of months after i came back from a very long vacation in the sun with sport and healthy food. i talked about that period to my docs because i felt amazing and almost cured. it probably was the testosterone.
this means that with a ""correct"" lifestyle my testosterone is adequate, which kind of crosses out hypogonadism.

Edited by magniloquentc0unt, 24 October 2013 - 06:39 PM.

[magniloquentc0unt]

I just discovered that testosterone variates heavily during the day, and since my analysis was done at 7pm where the levels are lowest this probably is not the source of my problems.
delays delays more delays