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[Bomb Jack]

<p>Hi everybody.<br></p><p><br></p><p>I'll try to be the most synthetic, because the matter is complicated.<br></p><p><br></p><p>So, in short, I am dysthymic and have anxiety problems.<br></p><p>Precedently, my therapist prescribed me sertraline and low dose amisulpride, but I refused the prescrition because of the sides of the amisulpride (hyperprolactinemia, weight gain, somnolence, withdrawal), then I went to a psychiatrist to be able to discuss the matter with, but we treated principally the subject of anxiety/panic linked to my next moving in another country all by myself (and in part starting a new life from zero) and so he prescribed me escitalopram 10mg/day; I accepted because&nbsp; now the most urgent thing is keeping the possible anxiety/panic at bay buy I know and feel that we're missing the other side of the puzzle (dopaminergic and maybe noradrenergic tone) (for exapmle lack of motivation and procrastination) to have more energy, drive, "mental stregth", and he refuses to prescribe me other medications synergizing with the escitalopram.<br></p><p><br></p><p>Of course I'll discuss this with my next doctor when I'll be in the USA (where I'm moving) yo see if we can reach some solution and agreement.<br></p><p><br></p><p>Now, I've been reasoning and musing extensively and this is the only place I know where I can ask an educated advice, based on knowledge: what I'd need is a dopaminergic antidepressant synergizing with SSRIs without chemical superpositions that preserves (or even enhances) the anxiolytic effect (and doesn't screw the dopamine system in the long term); so 5 routes I've found to be suitable for this case:<br></p><p><br></p><p>1. Wellbutrin XR/SR/LR/ER - NDRI but it seems to act principally on NA, which my psyc said could increase my anxiety (which I'm doubtous, however, because having tried multiple times Eph never gave me anxiety but a clear antidepressive feeling), but its widely cited as a positive reinforcer of SSRIs with reducing their sides and there's ample literature about it; also is labeled as an anxiolytic too.<br></p><p><br></p><p>2. Concerta/Equasym - DRI for the most; the route of the reuptake inhibitors would seem the more legit, because it should complementarize the effect of the SSRIs (same mechanism, other spectrum of neurotransmitters/symptoms addressed) without messing with particular receptors and releasing directly the neurotransmitter; but I really don't have idea if methylphenidate could give some advantage in depression<br></p><p><br></p><p>3. Selegiline/Deprenyl (Rasagiline it's too much expensive) 2,5mg sublingually EOD + 250mg (experimenting with the dosages) DLPA - MAOB inhibition with dopamine precursor to have a good dopamine tone: seems good solution also because there is no overlapping with the SSRI and no particular risk of negative interactions with anything (apart from stimulants and l-dopa, which I'll avoid), moreover it should be one of the most cheap solutions. It's a different method of having the same outcome of a DRI but with some added health benefits, but, like the others it's not selective as amisulpride and I don't know its possible effects on anxiety and long-term depression treatment (it should not have withdrawal problems, though).<br></p><p>Also, accepting suggestion on dosage and protocol.<br></p><p><br></p><p>4. Buspirone/Azapirones in general - 5-ht1a agonist and D2/alpha-2 antagonist, its considered an SSRI augmenter because of its action on 5ht1a receptor, whose agonism has antidepressive and anti-anxiety effect (seems perfect), from studies it also seems to induce a long term 5-ht2 downregulation (another good thing), also (another important aspect) it shares the same mechanism with amisuplride: <u>at low doses</u> it antagonizes mesolimbic (or limbic?) pre-synaptic D2 receptor (but not D3 - does it change anything?) producing a potentiation of the dopaminergic functions/tone in that area and I don't see cited any sides about weight gain and/or hyperprolactinemia (side question at the bottom), while it shouldn't give somnolence giving a bit of reflex energy instead because of the alpha-2 antagonism.<br></p><p>Now, I know that some 5-ht subreceptors downregulate both if they're agonized than antagonized: does 5-ht1a belong to this "family"? (otherwise it should be a bad case)<br></p><p>Does it have to be redosed during the day? I'm not sure about its halflife.<br></p><p><br></p><p>5. Chanoemeles Speciosa or Psoralea Corylifolia - DRI the first and NDRI the second. Both are herbs and their active compounds aren't standardized in the extracts available on the net. Both are not much studied but the second one it's definitely more studied, and it's also a natural MAOB-I (by different active compounds), so it should have an edge on dopamine. They're indicated to have antidepressive effects on the animals, and of course you shouldn't worry about finding a prescription or an online pharmacy which provide them, but they're a gamble... (also you should guess the dosage)<br></p><p><br></p><p>I'd also like to switch from escitalopram to zembrin later, because this is also a PDE4 inhibitor, mechanism which has proven antidepressive and anxiolytic properties and it can be succesfully emplyed for CILTEP, but this is a whole another story that I'll try to address in another future thread, because it must be a quite complicate subject. (coming off and AD and coming on another)<br></p><p><br></p><p>Lastly, about 4., the readings about dopamine effects on buspirone made me ask a thing: is it possible, by chance, that the cited sides I've always beleived about amisulpride are only relative to its use as antipsychotic (so high doses)??? (so using as a dopaminergic should have the double advantage of treating dysthymia/depression with avoiding the side effects)<br></p><p>In this case, rigth itself should be the solution, but in any case in the USA it is not available, so maybe buspirone could be the only substitute.<br></p><p><br></p><p><br></p><p>So, I showed all the consideration (it took me an hour to write this post), please, give me advice<br></p>